WO2013141870A1

WO2013141870A1 - Monitoring activities of ambulatory patients

Info

Publication number: WO2013141870A1
Application number: PCT/US2012/030194
Authority: WO
Inventors: Roman Ernesto PICHARDO
Original assignee: Draeger Medical Systems, Inc.
Priority date: 2012-03-22
Filing date: 2012-03-22
Publication date: 2013-09-26

Abstract

A server receives first physiological data and first location data that are from a patient worn device coupled to a communications network. The first location data is determined in response to the patient worn device being within a predefined proximity of a first tag having a known location. The server also receives second physiological data and second location data from the patient worn device. The second location data is determined in response to the patient worn device being within a predefined proximity of a second tag also having a known location. Thereafter, data is generated that characterizes all of the received data. Related apparatus, systems, techniques and articles are also described.

Description

MONITORING ACTIVITIES OF AMBULATORY PATIENTS

TECHNICAL FIELD

[0001] The subject matter described herein relates to the use of proximity protocols such as near field communication (NFC) to track patient location, distances walked, activity levels, other activities of daily living (ADL) and correlate same with physiological parameters.

BACKGROUND

[0002] Patients within telemetry care units of hospitals are typically coupled to continuous health monitoring sensors (e.g., electrocardiogram (ECG) sensors, blood oxygen sensors, etc.) for monitoring their health status. A patient admitted to a telemetry care unit has the benefit of not being permanently tethered to a wall mounted patient monitor and hence has the freedom of walking around the care unit. Patients can also wander to other areas within the hospital like visiting the cafeteria or gift shop. Many such patients must stay within the telemetry units for long periods of time which necessitate their ability to periodically leave their room (while at the same time being coupled to the sensors). In particular, a patient's physiological parameters are monitored such that if the parameters are outside a predetermined healthy range, the sensors generate an alarm. When an alarm occurs, the healthcare staff may waste life-saving time searching for the patient.

[0003] Patients within a telemetry care unit are often prescribed walking as walking promotes faster healing and may be used to judge the health of the patient. The degree to which patients tolerate walking sessions may be used by healthcare staff to indicate the patients health and recovery progress. Typically, walking sessions take place in the hallways of the telemetry care unit.

[0004] Patients are often required to walk a certain distance. For example, a prescription may be to walk 200 feet around the telemetry care unit facilities. Healthcare staff have no easy way to enforce the prescription and must rely on the patients word to ensure compliance. Depending on the patient's condition, a hospital staff (e.g. walking aide) may accompany the patient during the walk. Patients who do not fulfill the full prescription endanger their health because they are at risk of being discharged from the telemetry care unit before they are sufficiently recovered.

[0005] Another activity often prescribed to patients is to sit upright in a chair for a prescribed amount of time every day. With these activities, the healthcare staff challenge and expose the patient to levels of exertion similar to what they will encounter once they go home, but while still admitted in the hospital where any issues can be addressed if the patient's condition worsens. For both walking and sitting activities, the healthcare staff document and generate reports that include information such as distance walked, time spent walking or sitting, how well the activity was tolerated (good, fair, poor), and if assistance was necessary (for example, a gait belt or a walker).

SUMMARY

[0006] In one aspect, a server receives first physiological data and first location data that are from a patient worn device coupled to a communications network. The first location data is determined in response to the patient worn device being within a predefined proximity of a first tag having a known location. The server also receives second physiological data and second location data from the patient worn device. The second location data is determined in response to the patient worn device being within a predefined proximity of a second tag also having a known location. Thereafter, data is generated that characterizes all of the received data (e.g., locations travelled, times when the patient worn device is within proximity of respective tag, rates of travel, etc.).

[0007] The generated data and/or the first location data and the second location data can be used for many purposes such as characterizing activity of a patient wearing the patient worn device. The activity may be walking, sitting, or other activities of daily living (ADL). A report correlating activity with physiological parameters may be generated.

[0008] The first physiological and second physiological data may include data measured with an electrocardiogram sensor. They may include data measured with a blood oxygen sensor. The first physiological and the second physiological data may include an alarm.

[0009] The patient worn device may be temporally localized (i.e., the patient's location at a particular time may be determined) using the first location data and a time the patient worn device was within a predefined proximity of the first tag. The patient worn device may be temporally localized using the first location data and a time the data characterizing the first location data is received by the server.

[0010] The patient worn device and the first tag may use near-field communication (NFC) protocol, and the first tag may be a NFC tag. The patient worn device and the first tag may use radio frequency identification (RFID) protocol, and the first tag may be a RFID tag. The patient worn device and the first tag may use WiFi protocol, and the first tag may be a WiFi access point which encapsulates data identifying the first tag. The first tag may be connected to an accessory such as a gait belt or a walker. The patient worn device may be coupled to the communications network using BLUETOOTH protocol or WiFi.

[0011] The patient worn device may have a graphical user interface and feedback may be rendered to the graphical user interface in response to the patient worn device being within a predefined proximity of the first tag. The first physiological data and first location data may be rendered to a graphical user interface on a workstation coupled to the server.

[0012] In an interrelated aspect, the traversal of a patient is monitored using proximity based location protocols to localize the patient. Concurrently, at least one physiological parameter of the patient is monitored. Data is generated characterizing the monitored traversal of the patient and the monitored physiological parameter.

[0013] The physiological parameter may include the electrical activity of a heart of the patient. Additionally, the proximity based protocols may be near-field communication protocol and radio frequency identification protocol.

[0014] In a further interrelated aspect, a system includes a physiological parameter sensor, a proximity protocol reader, at least one data processor and memory. The memory stores instructions which, when executed by the at least one data processor, causes the at least one data processor to perform operations. The at least one data processor receives, from the physiological parameter sensor, data characterizing a physiological parameter. The at least one data processor also receives, from the proximity protocol reader, data encapsulated within a tag. The encapsulated data is received in response to the device being within a predefined proximity to the tag, the tag having a known location. Data characterizing the location is generated. The data characterizing a location and the data characterizing a physiological parameter is transmitted to a server.

[0015] The proximity protocol reader may be a near-field communication protocol reader. The proximity protocol reader may be a radio frequency identification reader.

[0016] Articles of manufacture are also described that comprise computer executable instructions permanently stored (e.g., non-transitorily stored, etc.) on computer readable media, which, when executed by a computer, causes the computer to perform operations herein. Similarly, computer systems are also described that may include a processor and a memory coupled to the processor. The memory may temporarily or permanently store one or more programs that cause the processor to perform one or more of the operations described herein. In addition, methods can be implemented by one or more data processors either within a single computing system or distributed among two or more computing systems.

[0017] The subject matter described herein provides many advantages. For example, the current subject matter enables healthcare staff to ensure compliance with a prescribed walking distance. Additionally, the healthcare staff can temporally localize a patient and remotely monitor the location and physiological parameters of the patient for physiological alarms. If an alarm occurs, the healthcare staff does not waste valuable time searching for the patient. Faster intervention can help save lives. The current subject matter also allows for tracking when and for how long patients use accessories like gait belts and walkers as well as tracking a patient's ADL, such as use of shower, toilet, chair, etc. [0018] The current subject matter also provides for an interactive device to engage the patient by providing feedback and positive reinforcement during their walks. Furthermore, by receiving data relating to physiological parameters and activity, the healthcare staff can correlate the patient's physical activity to the patient's physiological parameters to gain a better understanding of the patient's recovery status.

[0019] The details of one or more variations of the subject matter described herein are set forth in the accompanying drawings and the description below. Other features and advantages of the subject matter described herein will be apparent from the description and drawings, and from the claims.

DESCRIPTION OF DRAWINGS

[0020] FIG. 1 is a system diagram illustrating a patient worn device and a plurality of tags;

[0021] FIG. 2 is a process flow diagram illustrating receipt of physiological and location data from a patient worn device in response to proximity of the device to a tag;

[0022] FIG. 3 is an example patient status report illustrating physiological parameters, walking activity summary data, chair sitting activity summary data, and ADL summary data; and

[0023] FIG. 4 is an example patient report illustrating a comparison of physiological parameters and walking activity.

[0024] Like reference symbols in the various drawings indicate like elements. DETAILED DESCRIPTION

[0025] With reference to the diagram 100 of FIG. 1 , a patient 1 10 wearing a device 120 with physiological sensors (e.g. electrocardiogram (ECG), blood oxygen saturation (Sp02), etc.) measuring the patients physiological signals, can initiate communication with one of a plurality of tags 130; _{.. n}. Each tag may be located at a known location and may encapsulate data identifying the tag.

[0026] The patient 1 10 can initiate the communications by placing the patient worn device 120 in a physical proximity with one of the corresponding tags 130, _n. The tags 130; _, n can, for example, include near-field communication (NFC) protocol tags. The NFC tags 130j .. n include encapsulated data which identifies each tag and distinguishes the tags from each other. The data encapsulated therein is automatically passed to the patient worn device 120 (which in turn passes this information to a server 150) when the patient worn device is placed within a pre-defined proximity of the tag 130_{( n.} (which necessarily requires that the patient worn device 120 can read the corresponding tag). As used here, the NFC tag 130j._,._n can take a variety of forms including, but not limited to: tags, stickers, key fobs, or cards that do not require batteries.

[0027] The protocol used is not limited to NFC protocol, but may include radio frequency identification (RFID), WiFi (i.e. IEEE 802.1 1 family of standards), BLUETOOTH, or any other wireless protocol suitable to enable functionality of the current subject matter. In the case of WiFi, the strength of the WiFi signal received by either an access point or the patient worn device may be used to determine the proximity of the patient worn device from the access point. A more specific location may be determined by WiFi triangulation whereby the proximity of the patient worn device to two or more access points is measured. [0028] The patient worn device 120 is coupled to a communications network 140, via, for example, WiFi, cellular data protocol, etc. Also coupled to the

communications network 140 is a server 150 and workstation 160. As the patient worn device 120 enters the predefined proximity of a tag, the location of the patient worn device may be determined by the patient worn device and rendered to a graphical user interface on the patient worn device. The location and physiological parameters may be communicated to the server 150. Physiological parameters measured by the patient worn device and location information may be rendered to a graphical user interface on the workstation 160 for real time monitoring.

[0029] As stated above, the patient worn device 120 and the tags 130; _n can employ NFC. NFC is sometimes characterized as a set of short-range wireless technologies, typically requiring a distance of 20 cm or less. NFC operates at 13.56 MHz on ISO/IEC 18000-3 air interface and at rates ranging from 106 kbits/s to 424 kbits/s. NFC requires an initiator and a target; the initiator (in this case the patient worn device 120) actively generates an RF field that can power a passive target (in this case one of the tags 130,_{.. n}). However, in some implementations, NFC peer-to-peer communication can be implemented between the patient worn device 120 and the tags 130j _n.

[0030] The patient worn device 120 and tags 130;_.. ,_n can be configured to enable magnetic induction between two loop antennas (on each of the patient worn device 120 and the tag 130;_{... n}) located within each near fields of each respective loop antenna. In a passive communication mode, the initiator device provides a carrier field and the target answers by modulating the existing field. The initiator device may be the patient worn device 120 and the target may be the tag 130; _n. In this mode, the target may draw its operating power from the initiator-provided electromagnetic field, thus making the target device a transponder. In the active communication mode, both the initiator and target communicate by alternately generating their own fields. In this mode, either of the patient worn device 120 and the tag 130j_{. . n} can initiate the exchange of data.

[0031] FIG. 2 is a process flow diagram illustrating a method 200, in which, at 210, a server 150 receives, from a patient worn device 120, data characterizing first physiological and location data. The data is sent in response to the patient worn device entering a predefined proximity from a first tag 130,. The physiological data includes data measured or data calculated thereof by the physiological sensors of the patient worn device 120 such as, e.g., heart rate, ECG signals, blood oxygen levels, pacemaker pace rates, any physiological alarms, etc. The location data includes the identification of the first tag (i.e. the data encapsulated by and retrieved from the tag) or data characterizing a location associated with the first tag. Feedback may be provided to the patient from the patient worn device. When a patient begins an activity session, the patient worn device may render a display indicating and confirming that an activity session is starting. The confirmation feature may be enabled or disabled. Subsequent process displays may be presented to the patient as the patient worn device comes in proximity to other tags.

[0032] At 220, the server 150 receives, from the patient worn device 120, data characterizing second physiological and location data. The data is sent in response to the patient worn device entering a predefined proximity from a second tag 130jj. Since the first and second tags are separated by a distance, it may be inferred that the patient has moved between the two tags. As in step 210, the physiological data includes

physiological data measured or data calculated thereof by the patient worn device, and the location data includes data identifying the second tag, or data characterizing the location associated with the second tag.

[0033] At 230, it may be determined from the received data, information characterizing the activity of the patient. The activity may include walking activity (traversing between tags), sitting activity (staying in a proximity to a specific tag for a period of time, such as one located on a chair), ADL (staying in proximity to a tag, such as one located on a toilet or in a shower), the presence of a walking aid (gait belt or walker), etc. For example, walking activity may include total distance traveled, time between tags, speed (calculated from distance and time), etc. At 240, reports may be generated summarizing activity and correlating activity to physiological parameters and alarms.

[0034] FIG. 3 is an example patient status report 300, illustrating

physiological parameters and walking activity summary data. A report may be generated after walking sessions, at the end of the nurse shift, or as required (i.e. over any arbitrarily defined time period) and gives a reviewer insight into the health status of the patient. The report comprises a header 310, containing patient information. Physiological data such as heart rate (HR) trends 320, pacemaker activity 330, and alarm occurrence 340, may be presented. Additional physiological data may be presented. Summaries of activity may be presented such as walking activity 350, chair sitting activity 360, and ADL summary 370. The report enables healthcare staff to ensure compliance of patient ambulatory and chair sitting prescriptions and monitor other ADL.

[0035] FIG. 4 is an example patient report 400, illustrating a comparison of physiological parameters and walking, chair sitting, and ADL activity. A report may be generated after a walking session, at the end of a nurse shift, or as required (i.e. over any arbitrarily defined time period) and gives a reviewer insight into the health status of the patient and allows for a correlation of physiological parameters and activity. The report comprises a header 410, containing patient information. A graphical representation of the physiological data may be presented. In this example, the average heart rate 420 is shown. In the example, a walking session begins at time 422, and ends at time 424. A heart rate threshold 426 may be set to trigger an alarm if the patient's heart rate exceeds the threshold. A graphical representation of the walking activity may be presented. In this example, the average speed 430 and total distance 440 is shown. It may be inferred that the walking activity is correlated with the heart rate. The chair sitting and ADL activity may be presented, alone or in any combination with the walking activity, in a similar fashion to correlate activity with physiological parameters.

[0036] Location tracking and temporal localization may be performed using WiFi triangulation. The strength of the WiFi signal received by an access point may be used to determine the proximity of the WiFi transmitter from the access point; conversely, the strength of the signal received from an access point by a WiFi receiver may be used. A more exact location may be determined by measuring the proximity of the WiFi transmitter or receiver to two or more access points.

[0037] Various implementations of the subject matter described herein may be realized in digital electronic circuitry, integrated circuitry, specially designed ASICs (application specific integrated circuits), computer hardware, firmware, software, and/or combinations thereof. These various implementations may include implementation in one or more computer programs that are executable and/or interpretable on a programmable system including at least one programmable processor, which may be special or general purpose, coupled to receive data and instructions from, and to transmit data and instructions to, a storage system, at least one input device, and at least one output device.

[0038] These computer programs (also known as programs, software, software applications or code) include machine instructions for a programmable processor, and may be implemented in a high-level procedural and/or object-oriented programming language, and/or in assembly/machine language. As used herein, the term "machine-readable medium" refers to any computer program product, apparatus and/or device (e.g., magnetic discs, optical disks, memory, Programmable Logic Devices (PLDs)) used to provide machine instructions and/or data to a programmable processor, including a machine-readable medium that receives machine instructions as a machine- readable signal. The term "machine-readable signal" refers to any signal used to provide machine instructions and/or data to a programmable processor.

[0039] To provide for interaction with a user, the subject matter described herein may be implemented on a computer having a display device (e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor) for displaying information to the user and a keyboard and a pointing device (e.g., a mouse or a trackball) by which the user may provide input to the computer. Other kinds of devices may be used to provide for interaction with a user as well; for example, feedback provided to the user may be any form of sensory feedback (e.g., visual feedback, auditory feedback, or tactile feedback); and input from the user may be received in any form, including acoustic, speech, or tactile input. [0040] The subject matter described herein may be implemented in a computing system that includes a back-end component (e.g., as a data server), or that includes a middleware component (e.g., an application server), or that includes a front- end component (e.g., a client computer having a graphical user interface or a Web browser through which a user may interact with an implementation of the subject matter described herein), or any combination of such back-end, middleware, or front-end components. The components of the system may be interconnected by any form or medium of digital data communication (e.g., a communication network). Examples of communication networks include a local area network ("LAN"), a wide area network ("WAN"), and the Internet.

[0041] The computing system may include clients and servers. A client and server are generally remote from each other and typically interact through a

communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other.

[0042] Although a few variations have been described in detail above, other modifications are possible. For example, the logic flow depicted in the accompanying figures and described herein do not require the particular order shown, or sequential order, to achieve desirable results. Other embodiments may be within the scope of the following claims.

Claims

WHAT IS CLAIMED IS:

1 . A method comprising:

receiving at a server, from a patient worn device coupled to a communications network, first physiological data and first location data, the first location data determined in response to the patient worn device being within a predefined proximity of a first tag, wherein a location of the first tag is known;

receiving at the server, from the patient worn device coupled to the

communications network, second physiological data and second location data, the second location data determined in response to the patient worn device being within a predefined proximity of a second tag, wherein a location of the second tag is known; and

generating data characterizing all of the received data.

2. The method of claim 1 , further comprising:

determining, from the first location data and the second location data, information characterizing activity of a patient.

3. The method of claim 2, wherein the generating data comprises:

generating, from the first physiological data and second physiological data and the information characterizing the activity of the patient, a report correlating activity with physiological parameters.

4. The method of any of the preceding claims, further comprising:

temporally localizing the patient worn device from the first location data wherein the first location data further includes a time the patient worn device was within a predefined proximity of the first tag.

5. The method of any of the preceding claims, further comprising:

generating data characterizing a time the first location data is received; and temporally localizing the patient worn device from the first location data and the data characterizing the time the first location data is received.

6. The method of any of the preceding claims, wherein the activity is selected from the group comprising: walking activity, sitting activity, and activities of daily living.

7. The method of any of the preceding claims, wherein the first physiological data and second physiological data includes data measured with an apparatus selected from the group consisting of: electrocardiogram sensor and blood oxygen sensor.

8. The method of any of the preceding claims, wherein the patient worn device and the first tag use near-field communication (NFC) protocol, and wherein the first tag comprises a NFC tag which encapsulates data identifying the first tag.

9. The method of any of claims 1 -7, wherein the patient worn device and the first tag use radio frequency identification (RFID) protocol, and wherein the first tag comprises a RFID tag which encapsulates data identifying the first tag.

10. The method of any of claims 1 -7, wherein the patient worn device and the first tag use WiFi protocol, and wherein the first tag comprises a WiFi access point which encapsulates data identifying the first tag.

11. The method of any of the preceding claims, wherein the patient worn device has a graphical user interface and feedback is rendered in the graphical user interface in response to the patient worn device being within a predefined proximity of the first tag.

12. The method of any of the preceding claims, wherein the server is further coupled to a workstation, the workstation is configured to:

render to a graphical user interface, the first physiological data and the first location data.

13. The method of any of the preceding claims, wherein the first physiological data includes an alarm.

14. The method of any of the preceding claims, wherein the patient worn device is coupled to the communications network using BLUETOOTH protocol or WiFi.

15. The method of any of the preceding claims, wherein the first tag is connected to an accessory, the accessory being selected from the group consisting of: gait belt and walker.

16. A method comprising:

monitoring traversal of a patient using proximity based location protocols temporally localizing the patient;

concurrently monitoring at least one physiological parameter of the patient; and generating data characterizing the monitored traversal of the patient and the monitored at least one physiological parameter.

17. The method of claim 16, wherein the at least one physiological parameter

includes the electrical activity of a heart of the patient.

18. The method of claim 16 or 17, wherein the proximity based location protocols are selected from the group consisting of: near-field communication protocol and radio frequency identification protocol.

19. A system comprising:

a physiological parameter sensor;

a proximity protocol reader;

at least one data processor;

memory storing instructions which, when executed by the at least one data processor, causes the at least one data processor to perform operations comprising:

receiving, from the physiological parameter sensor, data characterizing a physiological parameter; receiving, from the proximity protocol reader and in response to the device being within a predefined proximity to a tag, data encapsulated within the tag; wherein a location of the tag is known;

generating data characterizing a location; and

transmitting the data characterizing a location and the data characterizing a physiological parameter to a server.

20. The system of claim 19, wherein the proximity protocol reader is selected from the group consisting of: a near-field communication protocol reader and radio frequency identification reader.