RU2251965C2 - Data analysis system in the field of telemedicine - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: selected reference point in every cardiac cycle on TP-segment. Values of neighboring N=2n+1 reference points also belonging to TP-segment are recorded, n=1,2,…, beginning from the first reference point. Other reference points are set to zero. The central reference point value is left without changes in a group of 2n+1 member. Reference point values of each of n pairs of reference points symmetrically arranged relative to the central reference point are scaled relative to condition U_j=U₀K_j, where U₀ is the central reference point amplitude, U_j is amplitude of j-th reference point pair, j=1,2,…,n is the number of each reference point pair relative to the central reference point, K_j is the scaling coefficients determined from received signal suppression condition of the first n spectral zones in spectrum. The so formed electrocardiogram signal reference point groups sequence is let pass through lower frequency filter with isoline drift signal being obtained being produced on output. The signal is amplified and subtracted from the initial electrocardiogram signal that is preliminarily delayed for lower frequency filter delay time. Device has the first lower frequency filter, discretization unit and unit for selecting anchor reference points connected in series, as well as subtraction unit, unit for saving N reference points, scaling unit, the second lower frequency filter, amplifier and delay unit. Output of the unit for selecting anchor reference points is connected to the first input of memory unit the second input of which is connected to discretization unit output. Each of N memory unit outputs is connected to one of N inputs of scaling units. Scaling unit output is connected to the second lower frequency filter input which output is connected to amplifier input. Amplifier output is connected to the first input of subtraction unit, the second output of subtraction unit is connected to delay unit output. Its input is connected to output of the first lower frequency filter. Subtraction unit output is the device output.

EFFECT: reliable removal of isoline drift.

2 cl, 8 dwg

Description

The invention relates to medicine and can be used for automated monitoring of the health status of remote patients in the field of cardiology using telemedicine information technology. Its use ensures the achievement of a technical result in the form of increasing the efficiency of diagnosis and treatment of patients by expanding the functionality and class of tasks.

The information and analytical system in the field of telemedicine is a complex multifunctional corporate system that combines both an information component that provides access to large databases of knowledge and a computing component that implements the procedures for inference, assimilation and monitoring of information.

The objective of the invention is to increase the effectiveness of therapeutic and preventive measures in the field of cardiology by automating the procedures for analyzing the patient’s condition on the basis of special software that uses formalized experience and knowledge of highly qualified specialists and combines all the elements of the system into a single complex. A telecommunications network provides communication between remote users, carriers and medical information processing facilities.

The telemedicine systems described in the book are known: Grigoryev A.I., Orlov O.I., Loginov V.L., Drozdov D.V., Isaev A.V., Revyakin Yu.G., Sukhanov A.A. Clinical telemedicine. - M .: Firma Slovo, 2001. In particular, on pages 18-20, the characteristics of a mobile telemedicine complex, developed for use on board the Space Shuttle and space stations and representing a set of programs and tools for receiving , digitizing and transmitting medical data in the form of audio and video signals. Another telemedicine system (p. 79-88) includes a computer with a network interface and peripheral equipment for the implementation of measures to ensure vital functions, preserving human health and working capacity in space flight conditions. However, these systems are based on the use of relatively expensive space communications and solve highly specialized data processing tasks. In addition, they lack components that ensure decision-making in conditions of incomplete medical information.

The closest in technical essence to the proposed invention is the hardware-software station for telemedicine “Ambulance-071YS”, which is an automated tool for consultative medicine designed to transfer clinical information from the Antarctic station “Vostok” to the mainland (see the section of the book “Telemedicine”. St. Petersburg: SpetsLit. 2001. p. 43-45. Authors A.K.Bladis and V.A. Dyuk). The disadvantages of the above system are the lack of a specialized knowledge base that ensures the functioning and adaptation of the system in conditions of incompleteness and uncertainty of the initial information, as well as a self-study unit focused on the perception of new theoretical and experimental data in the subject area and a communication unit with leading research, medical and preventive and diagnostic organizations and clinical centers in the field of cardiology.

Figure 1 shows the structural diagram of the system. Figure 2 shows the structural diagram of the means of adaptation. Figure 3 shows the structural diagram of the operational consultation unit.

Figure 4 shows the structural diagram of the intelligent interface. Figure 5 shows a block diagram of the functioning of the system. Information and analytical system in the field of telemedicine (Fig. 1) includes a workstation for a remote user 1, program control unit 2, adaptation unit 3, operational consultation unit 4, switching unit 5, cardiometer 6, EEG recorder 7, Akabane tester 8, temperature sensor and blood pressure 9, the Holster sensor system 10, a digital camera 11, an intelligent interface 12, a documentation unit 13.

The device is a problem-oriented complex based on a multiprocessor cluster and remote personal computers for creating, transmitting, processing, storing and displaying medical information in a computing environment using an intelligent interface and interactive mode, including expert systems technology, mathematical modeling tools, statistical analysis, as well as procedures that support in the dialogue mode the automated cycles of diagnosis and treatment used to solve Cardiology based on telemedicine information technology.

The information and analytical system in the field of telemedicine operates on the basis of the “Client - server” architecture and freely distributed software running the Linux operating system. For a parallel database management system (DBMS), the PostgreSQL system was used, which supports all SQL constructs, including user-defined nested queries and functions, which provides a powerful mechanism for storing and managing data. The listed system features allow you to implement management of a complex data model necessary for the functioning of an expert system.

The user's workstation (workstation - workstation of the attending physician) 1 operates on the basis of a personal computer and ensures the interaction of the doctor with the patient using medical devices and equipment 6-11, including a cardiometer, by recording and initial analysis of the electrocardiogram (ECG). The user's workstation 1 is connected to the intelligent interface unit 12. Entering patient data consists in filling out formalized forms, which for each data type are automatically generated and stored in XML format. The survey results are cached on the computer of the user's workplace (client) and, if necessary, can be displayed on the monitor screen without contacting the server. Hardware 6-11 provides operational monitoring and transfer of clinical research results to the program control unit 2 (the core of the cardiology complex), including text descriptions, medical images and indications of medical devices and equipment. To this end, mechanisms are used to maintain an electronic medical history and questionnaire survey data.

User 1’s workstation is implemented in Java, the code of which is used by a virtual machine (JVM - Java Virtual Machine), which is typical for many modern operating systems. During the operation of block 1 (doctor’s workstation), tasks related to the operation of devices and equipment 6-11, especially the cardiometer (client part of the system), and also through the network protocol, with the server part, which ensures: identification of the doctor and determination of access rights to history, are performed patient diseases; automatic reception of ECG data from a cardiometer, decoding and displaying them on the screen of a doctor’s monitor; dynamic generation of questionnaires for interviewing patients (passport, life history, examination) and displaying them on the screen to fill out or change; creating a local copy of the patient’s account card and synchronizing it with the data stored on the server; providing two-way communication with a specialist consultant; a request to the server to establish a diagnosis and make recommendations on the entered survey data or ECG; search for information on databases and knowledge (including the accumulated experience of specialist consultants and medical literature); display of necessary background information in a convenient form for perception; receiving from the server (block 2) medical information about the results of the diagnosis and the developed practical recommendations; displaying information on the screens of specialist consultant 2 and user’s workplace 1. In extreme situations associated with particularly complex, life-threatening cases of the disease, as well as difficulties in generating practical recommendations based on the diagnosis results in the program control unit 2 of the operational consultation unit 4 at the request of the unit program management 2 is carried out consultations with specialist consultants of leading research, treatment and prevention and diagnostic their institutions and clinical centers. The results are processed in the control unit 2, displayed on the screens of the specialist consultant 2 and the workplace of user 1 and transferred to the documenting unit 13.

Hardware for user 1 (client) workstation: processor class - at least Pentium II; the amount of RAM on the node - at least 64 MB; disk space - at least 10 MB; network connection with the server via TCP / IP.

The control unit of the specialist consultant 2 is an information and analytical center, implemented on the basis of a multiprocessor cluster. Block 2 provides monitoring and assessment of the patient's condition and contains an expert system. Block 2 is connected to the block of operational consultations 4, the adaptation block 2 and the block of the intelligent interface 12. The output of the control unit of the specialist consultant 2 are the results of the assessment of the patient's condition and the corresponding treatment and preventive recommendations.

The adaptation unit 3 (figure 2) provides for the implementation of the basic principles of the functioning of the system associated with self-tuning and self-training in conditions of uncertainty and incompleteness of the initial information. The adaptation unit 3 using direct and feedback interacts with the control units of the specialist consultant 2 and operational consultations 4. The adaptation tools include two blocks. The first block 14 refines the diagnosis data generated in the blocks of program control 2 and operational consultations 4, based on the methods of analysis and recognition of complex situations and procedures that provide replenishment of the knowledge base in the case when the conclusion according to standard rules does not lead to an informative result. The second block 15 implements the formation of a specialist model and its adaptation for a specific user on the basis of new data accumulated during the operation of control units 2 and operational consultations 4.

The model of the specialist (attending physician) 15 operates on the basis of the control unit 2. The model of the specialist 15 includes four modules: the first module 16 contains the individual characteristics of the specialist and the current state of his knowledge and skills; the second module 17 determines the requirements for the initial and final state of the specialist model; the third module 18 - typical errors and cognitive mechanisms and the fourth module 19 - psychophysiological characteristics of the interaction between the attending physician and the patient, which are formed during the consultation process and are used to organize and adjust the consultation process.

The block of operational consultations 4 (Fig. 3) provides additional consultations in extreme situations associated with particularly complex life-threatening cases of the disease on the basis of new data obtained by leading research, medical and diagnostic institutions and clinical centers in the process of conducting theoretical and experimental studies in the field of cardiology. The block of operational consultations 4 is interconnected with the block of program control 2 and consists of three main modules: the first module 20 provides telemedicine consultations (deferred or on-line); the second module 21 is designed to create, configure and verify expert rules based on information received both from external sources, as well as to generate and configure questionnaires for interviewing patients (passport section, life history, examination, etc.); the third module 22 performs the functions of monitoring and evaluating the individual actions of doctors for their certification, other functions of this module are monitoring the general situation in the region (region) and managing access rights: selecting users, delimiting access to data.

Hardware for operational consultation unit 4: processor class - at least Pentium II; the amount of RAM on the node - at least 64 MB; disk space - at least 10 MB; network connection with the program control unit (server) and adaptation tools via TCP / IP protocol.

The switching unit 5 contains a multiplexer, which ensures the interconnection of the user's workplace 1 with devices and equipment for monitoring the patient’s condition: a cardiometer 6, an EEG recorder 7, an Akabane tester 8, a temperature and blood pressure sensor 9, a Holster sensor system 10, and a digital camera 11.

The intelligent interface unit 12 (Fig. 4) operates on the basis of the control unit 2 and performs the function of combining knowledge of maintaining interaction through direct and feedback connections with the user's workplace 1 and the control unit 2. The principles of operation of the intelligent interface unit 12 provide formalization of concepts in the field of cardiology and are implemented in four main modules: a parser 23 that performs the procedures of morphological and syntactic analysis and implements a syntactic graph for pre input suggestions; semantic analyzer 24, using the results of parsing to build a graph that formalizes the information content of the input text; a conceptual dictionary processor 25, which is a library of functions providing the calculation of the characteristics of the concepts presented in the dictionary and a complete set of relations between them, as well as a fixed set of associative relations of the form “part - whole”, “symptom - diagnosis”; processor database guide 26, characterizing the model of the subject area (cardiology), which determines the functioning of the monitors of the attending physician 1 and specialist consultant 2.

The documenting unit 13 is connected with the workstation of user 1 and provides the automated generation of electronic patient records and patient logs containing general information about the results of control and the corresponding protocols for each patient.

The invention is illustrated in the drawing (figure 5), which shows a block diagram that implements the sequence of operations during the operation of the system:

using the run.bat file in block 1, the attending physician starts the program;

a window appears on the monitor screen asking for the name of the doctor and password;

user identification is carried out: a password is typed in order to check the selected language and register;

if the combination “doctor’s surname - password” is incorrect, a password violation message is displayed;

if the user identification was successful, the main program window opens;

Search for an account card by the patient’s surname from the available list;

if the patient was examined earlier, there is a card with the data of his examination;

if there is no data, a new patient card is started;

after choosing an account card or receiving a card from the server, the doctor can perform the following actions:

conducting diagnostic operations using a cardiometer and other instruments and equipment;

using the network protocol to work with the server part of the system, which is ensured by the sequence of operations:

automatic reception of ECG data from a cardiometer, other instruments and equipment, their interpretation and display on the doctor’s monitor screen;

dynamic formation of questionnaires for interviewing patients (passport part, life history, examination);

display of data in block 1 on the screen of the attending physician to fill out or change;

creating in block 1 a local copy of the patient’s account card and synchronizing it with the data stored in block 2;

the establishment of two-way communication between blocks 1 and 2, ensuring the interaction of the attending physician with a specialist consultant;

a request to the server (control unit 2) to establish a diagnosis and make recommendations on the entered survey data;

information search carried out by control unit 2 (including the accumulated experience of specialist consultants and medical literature);

display on the screen of a specialist consultant (block 2) of the necessary information in a convenient form for perception;

the logical conclusion carried out in block 2 and providing for the procedure for parallel processing of information based on:

inference by rules (rule-based) - using clear and fuzzy models;

case-based inference models - using forward and reverse search;

processing the results of inference using, taking into account the certainty and reliability of the information used;

in particularly complex, life-threatening cases of the disease, as well as in difficulties with the formation of practical recommendations based on the results of the diagnosis, the following actions are carried out in control unit 2:

in the control unit 2, based on information from the workplace of user 1, a request is made to the operational consultation unit 4;

in the block of operational consultations 4, an updated diagnosis is established and practical recommendations are developed on the basis of data received from specialist consultants from leading research, treatment and diagnostic institutions and clinical centers;

the admission to the workplace of a specialist consultant of the control unit 2 from the operational consultation unit 4 of medical information about the results of the diagnosis and practical recommendations;

transmitting to the adaptation unit 3 from the control unit 2 information from the operational consultation unit 4;

clarification in the adaptation unit 3 of the diagnosis data and recommendations generated in the program control unit 2 taking into account operational consultations 4;

analysis of the totality of information obtained in blocks 2 and 4, development of an updated diagnosis and relevant practical recommendations;

reception of the user’s workplace 1 from block 2 of medical information about the results of the diagnosis and practical recommendations;

displaying information on the screens of specialist consultant 2 and the user's workplace 1;

transfer of information from user’s workstation 1 to the documenting unit 13 for the automated generation of an electronic sheet and patient log containing general information about the results of control and relevant examination protocols.

Adaptation of the diagnostic program for a specific user (attending physician) is carried out on the basis of the specialist model 15, located in the adaptation tool block 3. The formation of the specialist model 15 is based on testing the knowledge and skills of the attending physician, as well as determining his individual characteristics, based on which the identification procedure is performed used in block 3 in figure 2.

Infomational-analytical system in the field of telemedicine works as follows. The computer of the attending physician turns on. The input signals for starting work are the control commands issued from the remote user 1. Under the influence of these commands in the unit of the multiplexer 5, a sequence of operations is carried out to interrogate the sensors of devices and equipment 6-11 and generate initial information about the patient's condition, which is transmitted to the control unit 2 specialist consultant for further processing and analysis, during which, in extreme situations, communication with the block of operational consultations 4 is used, the data from which Together with the results of a preliminary assessment of the situation in the program control unit 2, they are processed in the adaptation means block 3 and in a structured form are transferred to block 2 for the implementation of the final conclusion procedure, while the intelligent interface unit 12 performs the function of combining knowledge to maintain the interaction of the workstation of the remote user 1 s control unit 2.

The organization of computing operations during the operation of the system involves the processing of information in real time. A specific implementation of the system is carried out on the basis of a multiprocessor cluster, which provides operational processing of current information using the tools and methods contained in the control and adaptation units and connected via the Internet, which is a universal independent and accessible environment for building a telemedicine service, with personal computers of remote users and organizations providing operational advice in extreme situations. Documentation of the results of the system is performed using a printer connected to the workstation of a remote user.

Information support of the system is organized using a set of software tools and arrays of information contained in blocks 1-4 and grouped in special databases managed by an expert system included in the program control unit 2, taking into account the tasks of information exchange. When organizing telecommunications, organizational and technical means of protection are provided that prevent unauthorized access to patient data during the period of storage and transmission of information, and also ensures data integrity for subsequent medical decisions.

As a result of using the present invention, it becomes possible to form a flexible information space based on a multiprocessor cluster and personal computers, including mathematical modeling methods, customizable adaptive automated diagnostic cycles, taking into account the characteristics of the patient being examined and new knowledge obtained during the functioning of the system.

Claims (1)

An information-analytical system for telemedicine containing workstations for remote users connected by communication channels to the control unit of a specialist consultant and a multiplexer that provides communication with patient monitoring equipment and a unit for documenting diagnosis results, characterized in that the system contains an adaptation unit for self-tuning and self-training, operational consultation unit and intelligent interface unit, and the control unit of the specialist consultant contains expert system subject workstation connected to an intelligent interface unit, and a specialist unit, adviser unit connected to operational advice adaptation unit and the intelligent interface unit.

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