JP2000067139A - Electronic medical record system - Google Patents

Abstract

(57) [Summary] [PROBLEMS] To provide an electronic medical record system for estimating a disease that a patient is currently developing or may develop in the future from patient genetic information and patient diagnosis information. SOLUTION: The disease estimation means 13 reads out information stored in a gene database 11 and a medical chart database 12 and searches a correlation table 23 which stores a correlation between the genetic information and medical examination information and the disease to find out the possibility of onset. Are extracted and displayed on the input / output means 15. Based on the accumulated information, the disease estimating means 13 extracts a new correlation, adds it to the correlation table 23, and uses it for subsequent medical treatment. [Effect] It supports the doctor's decision making in diagnosis, and enables early detection and early treatment of disease.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an electronic medical record system used by physicians for medical practice, and more particularly to an electronic medical record system for estimating and presenting a disease having a high possibility based on both genetic information and medical examination information of a patient. .

[0002]

2. Description of the Related Art In conventional medical treatment in medicine, information such as an inquiry result and a test result is referred to as patient information, which is useful for diagnosis. In order to make a diagnosis, not only the current state of the patient based on the examination results, palpation, auscultation, and the like, but also the background of the patient before the consultation is used as very important information for the judgment. The background of the patient includes acquired factors such as lifestyle and inborn factors such as constitution and heredity, both of which are important. Information on acquired factors is collected mainly through interviews, and information on acquired factors is recorded after hearing the family history of the patient's parents and siblings. On the other hand, with the progress of genetic research, the genes involved in the development of certain diseases have been elucidated, and pre-symptomatic diagnosis has become possible. Diseases for which prediagnosis can be diagnosed from genetic information are expected to increase further in the future. (Special Issue “Genetic Research that Changes Daily Care”, Nikkei Medical, August 1997, pp. 60-71)

[0003]

[Problems to be solved by the invention]
Information on the current condition of the patient based on the test results, palpation, auscultation, and the like, and acquired factors such as lifestyle based on interviews are collected in relatively detail. However, in the conventional practice, information on the patient's innate factors was collected only for a family history. A family history is a record of the composition of several family members, such as the patient's parents and siblings, whether they are healthy, whether they have major illnesses, and if they have died, the age and cause of death, etc. It was done. Therefore, family history has little information,
The reliability of the information is low because it relies on the patient's memory. However, information on congenital factors, other than family history, can only be inferred from the progress of development, physical findings, and some of the findings from blood sampling, etc. Both were insufficient information.

[0004] On the other hand, with regard to genetic diagnosis, the actual diagnosis in clinical practice has been limited to specific genetic diseases that develop due to abnormalities in a single gene. Many diseases other than genetic diseases are caused by a combination of inherited factors due to inheritance and acquired factors such as lifestyle and environment.However, conventional genetic diagnosis approaches that use only information on innate factors are diagnosed. And it was difficult to predict the onset.

[0005] An object of the present invention is to provide an electronic medical record system for estimating a disease that a patient has presently or is likely to develop in the future based on both the patient's genetic information and the patient's diagnosis information. It is in.

[0006]

An electronic medical record system according to the present invention comprises a gene database storing gene information of a patient, consultation information such as a patient's chief complaint, a medical history, lifestyle and test results, a medical record, and a diagnosis result. Based on the information stored in both the gene database and the medical chart database, the disease database is stored based on the information stored in both the gene database and the medical chart database. It has a disease estimating means for searching and estimating a disease that the patient has presently or likely to develop in the future, and an output means for outputting the disease and disease information estimated by the disease estimating means and presenting it to the doctor . In addition, from the information stored in the gene database and the medical chart database, the disease estimating means extracts a new correlation between the diagnosis result of the doctor and the set of the patient's genetic information and diagnosis information, and stores the new correlation in the correlation table of the disease database. The stored information is updated and used for subsequent medical treatment.
Furthermore, consultation information stored in the chart database,
The medical record, the diagnosis result, etc., the disease estimated by the disease estimating means, and the disease information of the disease stored in the disease database are displayed simultaneously or switched on one screen using the output means. With the above configuration, it is possible to perform an accurate diagnosis and an accurate onset prediction based on both the patient gene information on the congenital factor and the diagnostic information on the acquired factor and the current condition.

[0007]

FIG. 1 is a diagram showing a configuration example of an electronic medical record system according to an embodiment of the present invention. The electronic medical record system according to the present embodiment includes a gene database 11 storing genetic information of a patient, a medical record database 12 storing medical examination information, medical records, diagnosis results, and the like of the patient, and a correlation between the genetic information, the medical examination information, and the disease. It has a disease database 14 storing relationships and disease information, a disease estimating means 13, and an input / output means 15. Based on information stored in both the gene database 11 and the chart database 12, the disease estimating means 13 is provided. Searches the disease database 14, estimates a disease that the patient has presently or is likely to develop in the future, and outputs the estimated disease and disease information from the input / output means 15. Hereinafter, an example of a process of estimating a disease will be described with reference to FIGS. 2 to 5.

First, an example of a format for storing necessary information in the gene database 11, the medical chart database 12, and the disease database 14 will be described.

FIG. 2 is a diagram showing an example of a data storage format in an embodiment of the present invention.

First, the gene database 11 stores information on a patient's gene in the form of a gene information table 21 shown in FIG. Gene information table 2
1 stores a patient ID 211, a gene ID 212, a gene name 213, a gene mutation 214, and the like. In the example of FIG. 2, the presence or absence of a mutation is represented by numerical values of 1 and 0, but the type of the mutation may be stored by a symbol. Also, instead of storing for each gene name, it may be stored as a set of the type of genetic test and the test result.

Secondly, the medical record database 12 stores consultation information such as chief complaint, medical history, lifestyle habits and test results as shown in FIG.
It is stored in the form of the consultation information table 22 shown in FIG. The examination information table 22 has a patient ID 221 and an item ID 2
22, an item name 223, a result value 224, and the like. FIG.
In the example of the above, the result of the interview is represented by being normalized to a real number from 0 to 1, but may be represented by a predefined alphanumeric character or symbol. The results of the biochemical tests and the like may be stored as the numerical values of the test results as they are.

Third, the correlation between the result value of the patient's genetic information and medical examination information and the disease that is likely to develop is stored in the disease database 14 in the form of a correlation table 23 shown in FIG. Store. The correlation table 23 has a correlation ID
231, a relational expression 232 indicating the correlation between the genetic information and the medical examination information and the disease, a risk factor 233 indicating the possibility that the relational expression 232 is established, the number of cases 234 indicating the number of cases where the relational expression 232 is established, and the like are stored. . Relational expression 232 may store a theoretically or statistically proven correlation,
The correlation extracted from the stored data by a method described later may be used.

In the example of FIG. 2, the relational expression 232 is if-th
Although it is described by the en type conditional expression, it may be described by a calculation expression using the risk factor as a solution. In addition, in the example of FIG. 2, the risk ratio is statistically indicated by the magnification of the onset probability compared to a healthy person of the same age of the same sex, but the onset probability itself may be indicated by a percentage.

Fourth, information on the disease itself is shown in FIG.
It is stored in the disease database 14 in the form of the disease table 24 shown in (d). The disease information table 24 contains the disease I
D241, disease name 242, diagnosis guideline 243, necessary test 244, complication 245, treatment method 246, and the like are stored.
The information stored in the disease information table is prepared for use by a doctor to confirm or make a treatment policy, but the information of 243 to 246 may not necessarily be provided. In FIG. 1, the gene database 11 is used.
The medical record database 12 and the disease database 14
Although they are described separately, information can be managed in the form shown in FIG. 1 or collectively managed by a single database, or can be managed in a distributed manner by a plurality of databases connected to a network. May be. In addition, literature (gene medicine,
Vol. 2, No. 1, pp. 135 to 145), and may be operated in cooperation with an international gene database or a disease gene database of a research institution in each country.

FIG. 3 is a diagram showing a flow of processing at the time of a normal medical examination in the present embodiment. At the start of a medical examination, first, the disease estimating means 13 reads information from the patient's gene database 11 and chart database 12 (reading procedure 3).
1) Correlation table 23 in disease database 14
Are extracted that satisfy the relational expression 232 (disease estimation procedure 32). In addition, the disease information relating to the disease indicated by the extracted relational expression is also stored in the disease information table 24 of the disease database 14.
Is read from. The information obtained by the above processing, that is, the gene information of the patient, the medical examination information, and the disease information of the estimated disease are displayed on the input / output means 15 so that a medical record can be entered (input / output procedure 33). While accepting the input of the medical record by the doctor, it is determined whether or not the medical examination is completed (the end determining procedure 34). If the medical examination is completed, the entered medical record is stored (the storing procedure 35), and the medical examination is completed. In step 35,
The medical record is stored in the medical record database 12 as the medical record table 123 as shown in FIG. 1, for example. Next, in step 33, various kinds of information are input / output
5 shows an example of display.

FIG. 4 is a diagram showing an example of screen display by the input / output means in the embodiment of the present invention. As shown in FIG. 4, the display screen 4 displays a patient name 41, a medical record 42, diagnosis support information 44, an end button 45, and the like. Patient name column 41
For example, the user selects a drop-down button on the right side of the display field to display a drop-down list, and enables a desired patient to be selected from the drop-down list. Further, the medical record 42 displays a record of past medical treatment read from the medical record table 123. The display area of the medical record is changed by a scroll bar on the right side of the display column, and the medical record can be referred to retroactively. In addition, past medical records are prevented from being deleted or edited, thereby preventing tampering. The entry may be input as free text via the input / output means 15,
It may be a selection input from a term list, or a combination of a free sentence input and a selection input. All other methods such as voice input and image input are also applicable.

The diagnosis support information column 44 displays diagnosis information, genetic information, and disease information in addition to the estimated disease indicated by the relational expression extracted in the procedure 32. Switching between these displays is performed by selecting the diagnosis support information switching tab 43 at the top of the diagnosis support information column. When the end button 45 is selected, the newly input medical record is saved, and the operation is completed. The input / output means 15 may be a device in which input means and output means are integrated such as a liquid crystal display integrated with a touch panel, or a combination of a plurality of independent input devices and output devices such as a keyboard, a mouse, a pen tablet and a display. good. Next, details of a display example in the diagnosis support information column 44 will be described.

FIG. 5 is a diagram for explaining details of a screen display example of the input / output means in the present embodiment. FIG. 5A is a display example of the diagnosis support information column when the estimated disease tab 51 is selected. When the estimated disease tab 51 is selected, an estimated disease list 511 and a relational expression column 512 are displayed in the diagnosis support information column. In the estimated disease list 511, the diseases extracted in the procedure 32 are displayed arranged in descending order of risk.
A physician can easily estimate the disease that a patient is currently developing or likely to develop in the future. In addition, the disease selected by the mouse or the like is highlighted by black and white reversal or color change,
The relational expression that led to the extraction of the estimated disease is shown in the relational expression column 512.
Will be displayed.

FIG. 5B is a display example of a diagnosis support information column when the examination information tab 52 is selected. Examination information tab 5
When 2 is selected, a diagnosis information list 521 is displayed in the diagnosis support information information column. The consultation information list 521 displays the consultation information such as the chief complaint, the medical history, the lifestyle, and the test result of the patient stored in the consultation information table 22, and the doctor can refer to the consultation information of the patient. If the contents of the examination information establish a relational expression for disease estimation, the correlation ID of the established relational expression is also displayed.

FIG. 5C is a display example of a diagnosis support information column when the gene information tab 53 is selected. When the gene information tab 53 is selected, a gene information list 531 is displayed in the diagnosis support information column. Gene information list 531
, The information stored in the gene information table 21 is displayed, and the doctor can refer to the patient's genetic information. If the content of the genetic information establishes a relational expression for disease estimation, the correlation ID of the established relational expression is also displayed.

FIG. 5D is a display example of a diagnosis support information column when the disease information tab 54 is selected. Disease Information Tab 5
When No. 4 is selected, the diagnosis support information column includes a disease name column 54
1, an item name column 542 and a content column 543 are displayed. The information stored in the disease information table 24 is displayed in the disease name column, the item name column, and the content column, so that the doctor can refer to various information related to the disease. The disease name column 541 and the item name column 542 form a drop-down list box like the patient name column 41, and a disease and an item can be selected from the drop-down list and the content can be displayed in the content column 543. When the disease ID, gene ID, item ID, etc. displayed in each list are selected and designated by double-clicking a mouse or the like, the display is switched to the corresponding disease information, gene information, and consultation information, and the doctor assists in diagnosis. Information can be sequentially referenced.

As shown in the above examples, the electronic medical record system of the present invention makes it possible to estimate a highly probable disease based on both genetic information and medical examination information of a patient. However, finally, the physician shall make a diagnosis at his / her own risk with reference to the disease estimated by this system.

According to the procedure described above, if the medical practice is continued using the present system, the genetic information of the patient, the diagnosis information, and the information of the diagnosis result are accumulated. As shown in FIG. 1, information on a patient's gene is stored in the gene database 11 in the form of a gene information table 21. On the other hand, the medical record information of the patient is stored in the medical record database 12 in the form of a medical examination information table 22. The medical record input by the doctor at the time of medical examination is also stored in the medical record database 12 in the form of a medical record table 123.
The final diagnosis result of the doctor may be stored as a part of the medical record in the medical record table 123, or may be stored separately in the diagnostic result table 124 as shown in FIG.

By using the information stored in the gene database 11 and the chart database 12 as described above, it is possible to extract a new correlation between the genetic information and the diagnosis information and the disease. Hereinafter, the extraction of the correlation will be described. In the medical care support system of the present invention, the disease estimating unit 13 extracts a new correlation between a diagnosis result of a doctor and a set of genetic information and medical information of a patient from the accumulated information,
The correlation table 23 of the disease database 14 is updated and used for subsequent medical treatment.

FIG. 6 is a diagram showing a flow of processing for extracting information for estimating a disease in the present embodiment. First, the disease estimating means 13 reads the accumulated gene information, diagnosis information, and diagnosis result (reading step 61). Next, a set of conditions of gene information and diagnosis information that have a strong correlation with a specific diagnosis result is extracted (condition extraction procedure 62). The set of conditions is, for example, if if as in the example of the relational expression 232 shown in FIG.
It may be a -then type conditional expression or a calculation expression having a numerical value such as a risk factor as a solution. To extract a set of conditions for genetic information and diagnostic information that have a strong correlation with a specific diagnosis result, use data analysis methods such as cluster analysis and discriminant analysis that search for causal relationships and patterns from a large amount of data. May be. Next, the extracted relational expression is displayed on the input / output means 15, and an input for selecting a relational expression determined to be usable by the doctor for medical assistance is received (input / output procedure 63). Next, it is determined whether or not the condition extraction operation is completed (end determination procedure 64). If the operation is completed, the selected relational expression is stored in the correlation table (storage procedure 65), and the extraction is completed.

According to the above method, the electronic medical record system of the present invention extracts a new correlation between a combination of patient's genetic information and medical examination information and a disease from the accumulated data, and allows a doctor to perform a subsequent medical treatment. Can be used for disease estimation. In addition, the extracted correlation is used only in the procedure 65 that the physician determines that the physician determines that the physician can use it for diagnosis support, so that the physician's judgment can be prevented from being confused by a medically meaningless correlation. .

[0027]

According to the electronic medical record system of the present invention, whether or not a patient has a current onset based on both the genetic information of the patient and medical examination information such as chief complaint, medical history, lifestyle habits and test results. Estimating a disease likely to occur in the future has a remarkable effect of assisting a physician in making a decision in diagnosis and enabling early detection and early treatment of the disease. This effect was not attainable with the conventional inquiries of patients, mainly through interviews, nor with the conventional genetic diagnosis of a specific genetic disease. It becomes possible for the first time with the present invention.

Further, based on the information of the patient's genetic information and diagnosis information and the results of the diagnosis accumulated by performing medical treatment using the electronic medical record system of the present invention, the combination of the patient's genetic information and diagnosis information and the disease And extract a new correlation with
There is a remarkable effect that the relational expression for estimating a disease is constantly updated, and medical treatment support by disease estimation based on the latest information becomes possible. The newly extracted correlation also has the potential to lead to new discoveries in genetic medicine.

[Brief description of the drawings]

FIG. 1 is a diagram showing a configuration example of an electronic medical record system according to an embodiment of the present invention.

FIG. 2 is a diagram showing an example of a data storage format in an embodiment of the present invention.

FIG. 3 is a diagram showing a flow of processing at the time of medical examination in an embodiment of the present invention.

FIG. 4 is a diagram showing an example of a screen display by an input / output unit in the embodiment of the present invention.

FIG. 5 is a view for explaining details of a screen display example of the input / output means in the embodiment of the present invention.

FIG. 6 is a diagram showing a flow of processing for extracting information for disease estimation according to the embodiment of the present invention.

[Explanation of symbols]

11: Gene database, 12: Medical record database, 123: Medical record table, 124: Diagnosis result table, 13: Disease estimation means, 14: Disease database
15 input / output means, 21 gene information table, 211
... patient ID, 212 ... gene ID, 213 ... gene name,
214: Gene mutation, 22: Consultation information table, 221
... patient ID, 222 ... item ID, 223 ... item name, 22
4: Result value, 23: Correlation table, 231: Correlation ID,
232: Relational expression, 233: Risk factor, 234: Number of cases, 2
4 ... Disease information table, 241 ... Disease ID, 242 ... Disease / syndrome name, 243 ... Diagnosis guideline, 244 ... Necessary test, 245 ... Treatment method, 31 ... Reading procedure, 32 ... Disease estimation procedure, 33 ... Input / output Procedure, 34 ... End determination procedure, 35 ...
Save procedure, 4 ... Display screen, 41 ... Patient name column, 42 ... Medical record, 43 ... Diagnosis support information switching tab, 44 ... Diagnosis support information column, 45 ... End button, 51 ... Estimated disease tab, 511
... Estimated disease list, 512 ... Relation formula column, 52 ... Diagnosis information tab, 521 ... Diagnosis information list, 53 ... Gene information tab, 531 ... Gene information list, 54 ... Disease information tab,
541: disease name column, 542: item name column, 543: content column, 61: read procedure, 62: condition extraction procedure, 63: input / output procedure, 64: end determination procedure, 65: storage procedure.

Claims (3)

[Claims] 1. A gene database storing gene information of a patient, a medical chart database storing medical information of the patient, a disease database storing a correlation between the genetic information and the medical information and the disease, and disease information. When,
Disease estimating means for estimating a disease that the patient has presently or is likely to develop in the future by searching the disease database based on information stored in both the gene database and the medical record database And an output unit that outputs the disease estimated by the disease estimation unit and the disease information. 2. The electronic medical record system according to claim 1,
From among the information accumulated in the genetic database and the medical chart database, the disease estimating means extracts a new correlation between a diagnosis result of a doctor and a set of the genetic information and the medical examination information of the patient, and An electronic medical record system characterized by updating information stored in a correlation table of a database. 3. The electronic medical record system according to claim 1, wherein the medical examination information stored in the medical record database, the disease estimated by the disease estimating means, and the medical information stored in the disease database. The electronic medical record system, wherein the disease information of the disease is displayed using the output unit.