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Patient Monitoring Systems - Current and future possibilities of Medical Informatics

This is a text written by Jon Berg <jon.berg|a|turtlemeat.com> spring 2005 in the Computer Science course Medical Informatics at Tromsø University, Norway.

Current and future possibilities of Medical Informatics

Table of Contents

9. Patient Monitoring systems

Patient monitoring systems is the term for all the various devices that are used to supervise patients. One category of such devices is devices that alerts if the patient gets into a critical state. Example of one such device is a heart monitor.

 

The need for patient monitoring is apparent in situations where the patient is:

  • In unstable physiological regulatory systems, for example in the case of a drug overdose or anesthesia.
  • In a life threatening condition, for example where there are indications of a heart attack.
  • In risk of developing a life threatening condition.
  • In a critical physiological state.

 

Patient monitoring is not a new in health care. The first primitive patient monitoring started with the work done by Santorio in 1625 that was measuring of body temperature and blood pressure. The development of new technology after World War 2 and up to today has developed a vast amount of different types of monitoring that can be done.

 

Patient monitoring today

To a large extent computer based monitoring and intensive care unit systems have become cheap enough to be deployed on a large scale in many intensive care units around the world. The bedside has become an important point of displaying data. Bedside monitors have capabilities of intelligent monitoring, intelligent alarming, plug and play modules, TCP/IP and Ethernet networking and many other features provide easy, integrated monitoring in any facility. The systems often provide database and analysis functions that previously only was available on large systems. Most bedside monitors sold today can incorporate data from clinical laboratories, bedside laboratories devices. The drawbacks of these features are that they usually have proprietary communications protocols and data acquisition schemes.

 

Pictures of bedside monitors

1 BSM-2303

2 BSM-951

Pictures of the bedside monitors from https://www.nihonkohden.com/products/monitor/

 

The patient monitoring data only make up for 13 % of the total information used by doctors in the treatment of the patient. Other information sources that has to be taken into account is laboratory results, observation, drugs used, blood samples etc. These other systems used to document medication (Medication Administration Record) and Intensive Care Unit flow sheets applications have little support for interchanging information between them, and the health workers often have to chart the same information in multiple systems.

 

Future of Patient monitoring systems

A lot of the patient monitoring systems that are described in Medical Informatics (Shortliffe. Perreault. Wiederhold. Fagan. 2000. Medical Informatics. New York: Springer-Verlag) is based on stationary systems. The most foresighted example is where the book describes an example where a doctor receives an alert for a urine condition on one of his patients on his pager. This could be a taste for what possibilities there are for patient monitoring in the future. How the systems of tomorrow will look like will of course be just speculation.

 

It is likely that the doctors and nurses would want to be mobile. When they visit a patient they could have a tablet PC with all the current charts and data for that particular patient ready. The architecture for supporting this could be designed in different ways, but the main parts that have to be realized would be:

  • An infrastructure for the monitoring devices to push their data into, for example a server with a database.
  • An infrastructure for the mobile devices to get the data.
  • It could also be realized in such way that the monitoring device stores all the data and applications needing data connected directly to the monitoring device.

 

If this becomes the reality it raises a big question for how the data security must be. Any data associated with a patient is confidential, and must be treated with the highest importance. The standards for wireless networking used today may not be as secure as needed. Some of the things that have been critic raised at the standards today are that they offer very little support for frequent updating of the encryption keys.

 

Medical applications such offering various alerting and monitoring is very crucial that they have a high availability and run stable. When a person’s life depends on it there must be high guarantees that the technology doing the monitoring do not fail. In a wireless setting the system must be designed in such a way that it can deal with less reliability. For example if health workers were to be alerted from a monitoring device through wireless it could be possible that the person was out of reach from the wireless network. This may not be a problem as long as it is not a critical emergency. If it is something that has to be dealt with within the day it can be sufficient to try to resend the message or resend it to somebody else that can deal with it. When it comes down to how it actually is going to be used it is likely to see two cases; real-time alerting which is the primary use of patient monitoring systems, and second use of the data for diagnostic of patients. The real time alerting must be dealt with in a critical way, and wireless for these types of applications is probably not wise. The use of patient monitoring data in consultation is probably likely that can be done wireless. It is not that critical, in the case where wireless network connection fails the doctor can probably go somewhere to get better wireless connection, or transfer the data through other means.

 

The interchange and integration of information should be better. The need for this has already been established today. It is inefficient to must enter data in multiple systems and use many different systems to get a “total picture”. It would be useful to have patient monitoring data integrated in patient journal systems. And vise versa have patient journal data available in the patient monitoring charting applications.



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