Patient monitoring and care systems - Bioinformatics · PDF file2 Concepts of patient care Patient care begins with data collection and assessment of current patient status. Decision

Patient monitoring and caresystems

Dr. Adrian Mondry

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Concepts of patient carePatient care begins with datacollection and assessment ofcurrent patient status.

Decision making as to therapeuticgoals and diagnostic means follows.

At specified intervals, the patient isre- assessed, and objectives are re-defined.

Multidisciplinary tasks makeprocess more complex.

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Information needs for patient care

Who is involved in patient care?

What information needs has the individual professional?

From where, when, and how does this information come?

What information does each professional generate?

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Patient care systems: history

1965 Technicon Medical Informatics System (TMIS) in Californiawith purpose to simplify and standardize documentation.

Change in demands:

1970s- 1990s: shift from single institution to integrated deliverysystems.

1980s- 1990s: shift from “fee for service” to “prospective payment”to “capitation” => new need for information on costs

1970s- 1990: shift in methods of quality assessment fromretrospective audit to concurrent influencing, and need for datacapture for benchmarking purposes

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Patient care systems: history

Patient care systems were separately introduced in hospital careann ambulatory setting, due to different needs.

In 1980s, most common systems were supporting nursing careplanning and documentation.

Ambulatory systems used paper- based documentation that waslater transferred to computer.

Modern systems have direct input with little free text capacity.

Voice recognition technology is advancing.

Need to switch from a patchwork of systems to integrated systemis there, but task very demanding.

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Patient care systems: current research

Formulating models for acquisition, representation, processing,display and transmission of biomedical information.

Developing innovative computer based systems, using thesemodels, that deliver information or knowledge to healthcareproviders.

Installation and reliable functionality in real life.

Study of the effects of such systems on reasoning and behaviourof health care providers.

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Patient monitoring systems

• “repeated or continuous observations or measurementsof the patient, his physiological functions, and thefunction of the life support equipment, for the purpose ofguiding management decisions, including when to maketherapeutic interventions, and assessment of thoseinterventions”. Hudson L. Respir. Care 1985; 30: 638 ff

…what is it?

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History (1/3)In 1625, first methods for temperature measurement andpulse rate measurement, were published in Italy bySantorio.

In 1707, Sir John Floyer published “Pulse- Watch”.

In 1852, the first fever curve was plotted by Taube.

In 1896, the blood pressure cuff was invented by Riva-Rocci.

In 1903, Einthoven invented ECG measurement

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History (2/3)Since 1920, the four vital signs: blood pressure, pulse rate,temperature and respiratory rate, have been recorded in allmedical charts.

Concomitantly, development of transducers and electronicinstrumentation increased the number of physiologicalvariables that could be monitored.

In the 1950s, the concept of ICU was created, initially aspost- operative recovery rooms, then more variations cameabout, including from the 1960s coronary care unitsmonitoring cardiac rhythmicity.

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History (3/3)1966: Shubin & Weil in Los Angeles took computers to the ICU.

Objectives:-increase availability and accuracy of data

-Compute derived variables that cannot be measured directly

-Increase patient- care efficacy

-Allow display of time trend of patient data

-Assist computer aided decision making

Today, systems with database functions, reprot generationsystems, and some decision making capabilities are calledcomputer- based patient monitors, while the basic signalconversion and storage is built into monitors and considered“patient monitoring”

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Data acquisition & signal processing (1/4)

Advantages of built- in microcomputers:

-Pattern recognition and feature extraction

-Monitoring of signal quality

-Early conversion to digital form, then processing

-Easier transmission of digitized signals

-Easier storage for later review

-Stored variables can be graphed over longer periods

-Smarter alarms

-Easier upgrade (software instead of hardware)

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Arrhythmia monitoring- Signal acquisition and processing:

-ECG arrhythmia analysis is a most sophisticated task

-Conventional, i.e. human monitoring, is expensive, unreliable, tedious andstressful.

-Arrhythmia monitoring systems with central computer, monitoring 8- 16patients, introduced in late 70s

-Arrhythmia monitoring now integrated into bedside monitors

-These retain ECG tracing record

Wave form classification:Incoming waveshapes are compared to stored templates, which in turn areupdated

Full- disclosure and multi- lead ECG monitoringModern central monitors can store several days of signals, combined withdigital waveform analysis

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Bedside point of care laboratory testing:

Over the past decade, standard laboratory tests havebeen made available as point of care test, in whichanalyses are performed by bringing a blood sample incontact with a reagent pack.

Results can be displayed on the bedside monitor andstored for comparison with previous results.

Link with other (central) laboratory data storage devicesallows integration into patient’s record etc.

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Commercial development:

Development based on standard microcomputer basedserver hardware and software platforms has led to widescale distribution.

Over 2000 ICUs worldwide use such systems.

Bedside monitor is focus of development

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To cater for the needs of specialized demands, specificICU systems have been developed.

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Information management in the ICU (1/4)

More analyses => more data => higher chance to miss data =>

Need for well organized data: medical record must guarantee thecontinuity of data.

Computer based charting:

1984 Bradshaw et al. showed that bedside monitors accounted foronly 13% of physicians’ decision making => need to integrate datafrom various sources into unified medical record.

Display must fulfill practical needs (day- to- day, weekly summary)

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Calculation of derived variables :

Relieves end user and frees him to do more practical work,speeds up decision making.

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Decision making assistance :

System collects and integrates patient data from a wide variety ofsources.

New information is immediately processed by fixed algorithms todetermine whether it alone or in combination with existing dataleads to new decision making process.

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Response by health care professionals :

Computerized systems that are tailored to the practical needs arewell received by staff.

So far, however, no benefit regarding time saving has beendemonstrated.

An unpublished study (Dorenfest and Associates, Chicago 1989)found that there is time saving of about 25% regardingadministrative work done by health care professionals.

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Current issues in patient monitoringData quality and data validation.

Continuous vs. intermittent monitoring

Data recording: frequency and quantity

Integration of patient- monitoring devices

Treatment protocols.

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Questions you should know toanswer after this lecture:What is patient monitoring, and why is it done?

How do computer- based patient- monitors aid healthprofessionals in collecting, analyzing and displaying data?

What are the important issues for collecting high- quality dataeither automatically or manually in the intensive- care unit?

Patient monitoring and care systems - Bioinformatics · PDF file2 Concepts of patient care Patient care begins with data collection and assessment of current patient status. Decision

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