Data processing: financial – business practice – management – or co – Automated electrical financial or business practice or... – Health care management
Reexamination Certificate
1996-02-02
2004-01-27
Cosimano, Edward R. (Department: 3629)
Data processing: financial, business practice, management, or co
Automated electrical financial or business practice or...
Health care management
C128S924000, C128S925000, C345S215000, C345S215000, C715S252000
Reexamination Certificate
active
06684188
ABSTRACT:
FIELD OF INVENTION
This invention relates generally to the production of technical documents and more particularly to the production of electronic medical records by mobile health care workers.
BACKGROUND OF INVENTION
As the entire world struggles through the transition from the industrial to the information age, the need for information and document management is felt throughout the workplace. Medicine can be considered a prototypical field where that need is acutely felt. In medicine, as in many other fields, the increasing risk of litigation, the presence of third party payers, and the increasing complexity of the work have lead to a mountainous burden of paperwork.
Modern patients lament the fact that physicians don't spend as much time with them as Marcus Welby would have. Few realize that most doctors spend at least as much time on paperwork as they spend directly with a patient for any given encounter. Superficial, cursory physician/patient encounters are not acceptable but unfortunately the work of documentation must be done and we cannot turn back the clock. Our only hope of improving this situation is to make the documentation process more efficient.
Structured Documentation
Through the years, individuals have sought to improve the process of documentation in several different ways. Kempster (U.S. Pat. No. 3,960,634, 1976) sought to simplify the process by adding adhesive sheets to an existing record, thus adding small amounts of information to a preexisting record in an incremental fashion. Sonsteby (U.S. Pat. No. 4,865,549, 1989) attempted to add structure to the documentation process. She utilized color coded adhesive labels to organize the document and eliminate omissions of crucial data elements.
The concept of structured documentation is not new. It should be considered simply a way to practice good medicine. It is often estimated that in medicine the correct diagnosis is revealed in the patient's history as often as 90% of the time. A structured interview is simply a way of enhancing the quality of care by reminding the physician not to omit important details. An example of structured documentation is noted in one of the earliest textbooks still in widespread use today (The Early Diagnosis of the Acute Abdomen, Sir Zachary Cope, 1921, 15th ed., pg 21). The concept is still being refined and improved today (Wrenn, et al.: The use of structured, complaint-specific patient encounter forms in the emergency department.
Annals Emergency Medicine
, May 1993; 22:805-812). Unfortunately these attempts all comprise written manual methods. Attempts to incorporate information age technologies to bear in the medical profession have thus far been less than successful.
Visual Images
Others sought to improve upon the documentation process by adding visual representations to their documents. Assuming “a picture is worth a thousand words” these individuals felt that they could improve the documentation process and avoid long winded descriptions. Abramsom (U.S. Pat. No. 3,951,062, 1976) accomplished this by using a rubber stamp which consisted of an outline of a particular anatomic structure. Rees (U.S. Pat. No. 4,869,531, 1989) accomplished the same goal by using adhesive backed stickers with drawings of anatomical structures that could be mounted on the chart. In either case the physician could then add the particular elements of the individual case to the outline or scaffold drawing. This could be accomplished in a relatively accurate fashion without the need for great artistic talent on the part of the user.
Mobile Workers
Fuller (U.S. Pat. No. 4,038,666, 1977) attacked a different problem. How could documentation be performed by a mobile worker? His device, known as a “portable medical data recorder” consisted of a roll of paper on two rollers encased in a device with a window for writing. When the paper in the window was filled, the paper could be advanced and a fresh writing surface exposed.
Dictation/Transcription
All of these were manual methods that required written input on the part of the user. Documentation was still very time consuming and produced only a physical paper record. Eventually some modern technological methods were applied in order to increase the efficiency of the professional user who needed to produce documentation. The most important of these was dictation and subsequent transcription. We are not aware of any patents relating to standard transcription methods even though they are in widespread use. The method is quite obvious i.e. a tape recorder and a typist. Jachmann and Sweet (U.S. Pat. No. 5,146,439, 1992) developed a more advanced form which they described as “digital dictation” but this was a technical innovation that had little impact on the individual performing the dictation or on the final document produced.
Dictation/transcription systems are in widespread use today. These systems have several drawbacks:
1) Compared to writing or typing, there is a clear time saving for the individual doing the dictating. However, this is simply represents a cost shifting mechanism. Transcribing is still very labor intensive and skilled transcriptionists are still in short supply in most areas.
2) Similar scenarios require repetitive duplicate dictation on the part of the dictating user. Some have attempted to overcome this drawback by combining transcription with the use of “boiler plate” methods. A boiler plate is where a variable is inserted in the context of some preexisting text. This is seem in the mail merge functions of many word processors.
3) Transcription does not even come close to the dream of the “Electronic Medical Record” so often discussed among health care planners. There are three reasons for this.
a) Transcription still produces a paper document in most cases. Although most modern transcription centers use computerized word processors the transcribed documents are almost always printed to paper before there are reviewed or distributed. The electronic file produced by the transcription software is rarely transmitted or archived in its electronic state. The paper document is often reproduced by photocopying or transmitted by facsimile machine and this requires additional time and effort. If one then wishes to transmit or store the paper document by electronic means, it must first be converted, usually by means of an optical scanner. This adds a redundant step to the work.
b) Even if they are scanned into electronic documents, most documents are simply scanned as a graphical image not as text files. Optical character recognition is an additional step that still requires an operator to proofread and correct the document.
c) Even if the document is scanned, converted and stored in a text based format, it is still very difficult to retrieve data for outcome studies (very important for health planning). This is because the data is not input in any sort of systematic format. The same physical symptom could be known as chest pain, chest pains, substernal pain or pains in the chest. Complex search engines must be utilized to extract any meaningful data from free text documents. This can be very labor intensive as well.
Computerized Medical Records
As computers have become common place over the past decade it is only logical that they would be utilized to address these problems. Buchanan and Dowdle (U.S. Pat. No. 5,148,366, 1992) developed “computer-assisted documentation system for enhancing or replacing the process of dictating and transcribing”. They themselves described their technique as a “boiler plate” methodology. It is much like the process commonly described as “mail merge” in word processing systems. Buchanan and Dowdle (U.S. Pat. No. 5,267,155, 1993) later improved upon their system by adding a relational database.
Computerized Speech recognition
One of the leaders in the field of document production over the past few years has certainly been Kurzweil AI, Inc. Kurzweil Al has been a dominant market player in the field of medical record production. Investigators at Kurzweil hold at least ten patents. Nine of these rel
Mitchell Geoffrey C
Rudy Douglas D
Cosimano Edward R.
Porter Wright Morris & Arthur LLP
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