FIELD OF THE INVENTIN

The present invention relates to the field of medical equipments for simultaneously monitoring plurality of patients. More particularly, the invention provides asystem for providing continuous expert - network critical care services from a remote location. A plurality of patient-vital sign monitors grouped & placed at triage sites or inside intensive care units are connected over a network to a central nursing station which is manned by caregivers & triage decision makers on 24/7 basis.

BACKGROUND AND THE PRIOR ART

It has been found that nurses' salaries account for considerable chunk of a hospital's operating budget, and that they spend 20%-35% of their time performing clerical and communications tasks. Because of changes in government regulation, insurance reimbursement policies, and competition, hospitals are increasingly under pressure to reduce their operational costs. As a result, hospital occupancy and patient length of stay have decreased, and more hospital patients are acutely ill. However, staffing levels have been reduced to cut costs. Thus, hospitals are providing care for sicker patients with fewer people, and there is a significant need for making those people more productive through hospital automation

Many hospitals still use hand-written white boards to broadcast patient information to hospital staff and thereby facilitate efficient healthcare service. These white boards are large and prominently displayed such that patient information is readily available to hospital staff. A negative result of these large and prominently displayed white boards is non-hospital staff, for example visitors, media reporters also have access to patient information. Thus, traditional hand-written white boards create patient privacy concerns. Further, because of public accessibility, these traditional hand-written white boards may violate the Health Insurance Portability & Accountability.

Response to mass casualty incidents poses numerous challenges to the emergency medical services community. The rapid and accurate triage of patients is a critical step of the response process and triggers a chain of events that will result in efficient resource allocation. Responders/emergency nurses used to conduct initial triage at the incident by attaching red, yellow, green or black colored paper tags to patients based upon assessed priority. Each responder periodically reports their triage counts to a triage officer. Triage officers then delegates this information to other officers and the incident commander, who each in turn uses this critical initial information to coordinate on-site treatment resources, transport vehicles, and off-site care facilities for the patients.

For years, responders performed these critical tasks with mouth to mouth communication, paper triage tags, clipboards, and voice communication (telephones and hand-held radios). This prior art workflow, however, has proven labor intensive, time consuming, and prone to human error. Officers may be forced to coordinate personnel and transport vehicles with insufficient information from responders in the field. Receiving hospitals must prepare for the incoming patients without any prior information on the number of patients expected or the types of injuries. In an understaffed response team, patients with significant injuries may deteriorate and remain undetected while waiting for transport.

Children who are obviously unstable are triaged first without vital sign measurement at triage in the pediatric and most other triage systems. Paradoxically, it is the children who at first glance do not appear unwell who need the closest triage assessment to ensure correct prioritization, especially Triage Early Warning Score consisting of mobility, respiratory rate, pulse, temperature, level of consciousness and presence of trauma and reliance on routinely recorded vital signs. Triage in emergency care is a process of collecting pertinent patient information and initiating a decision making process that categorizes and prioritizes the needs of patients seeking care. Triage is performed by a registered nurse. The triage nurse may be the first to encounter a patient experiencing a cardiopulmonary event. . A specific amount of time and experience in emergency care alone may not ensure that a registered nurse is adequately prepared to function as a triage nurse.

Manually done multiple casualty triages is a process designed to priorities casualty care at the scene of an incident to ensure care is available to those who need it most urgently and that the greatest number of casualties survive. Pre-hospital ambulance paramedics need to manually assess each injured person and establish priorities of care and evacuation from the scene. This is an exceptionally difficult task that needs to be completed in a timely manner to improve the chances of survival or at least to minimize the extent of injury and subsequent rehabilitation for the casualties. Triage remains a process that requires expert judgment in a complex and time critical situation to maximize casualty outcomes.

During mass casualty incidents, an enormous amount of data, including the vital signs of the patients, the location of the patients, and the location of the first responders must be gathered and communicated efficiently constructed scalable algorithms to monitor a large numbers of patients, an intuitive interface to support overwhelmed responders, and an ad-hoc mesh network that maintained connectivity to patients in ad-hoc, chaotic settings, design that allows for the collection of a massive amount of data and presents this data in a clear and understandable format to the user.

Manual team triage in the prior art means that triage is performed by a team consisting of different categories of staff (physician, nurse, assistant nurse).

US3599199 discloses a system for indicating to a plurality of administrative stations, by signal means, the status of the individual unit. Preferably, the administrative station adjacent the unit has means controlling the signals to energize the signaling means in all stations simultaneously to indicate the status of the unit. For example, in a hospital the system would indicate the status of a patient- bed unit. It would be controlled at the nurses' station to supply the proper signals to energize the signal means and alert the cashier, admitting office, housekeeper, dietician and other desired administrative stations that the bed is occupied, the patient is to be discharged, the patient has left the bed and it should be made up, and that the bed is ready for occupancy so that each administrative station can be ready to perform its required function. Heretofore in a hospital, for example, the records for each patient-bed unit were filed in filing cabinets at each administrative station and the status of each unit was not readily discernible. When there was any change in the unit status, it was necessary for the nurse or someone to advise each station individually. The record was then removed from the file and acted upon accordingly.

US3913092 discloses a method and at least one apparatus for performing the method for transmission of critical information from an ill person in a house to any person outside are disclosed. The apparatus comprises a rectangular housing having means for mounting in a window of the ill person's room, a HELP sign on a transparent front surface, an opaque rear surface having a card holder thereon encircled with a row of holes, a critical information card having the likely diagnosis or disability of the ill person in the card holder, a clock mounted on one side of the housing, an easy-to-operate switch on the housing for a flashing light circuit therein, which upon actuation by the ill person, the flashing light makes the HELP sign a first attention calling means for attracting the attention of people outside the house, the encircling row of holes becomes a line of flashing lights comprising a second attention calling means on the housing for attracting attention of people inside the house to the card holder containing the critical information card therein, and the clock is started to indicate the lapse time since the ill person first energized the system.

US4216462 discloses a system composed of a plurality of bedside stations, each in the vicinity of a hospitalized patient, and each interconnected to a central station for monitoring and controlling the bedside stations. The bedside stations contain a plurality of physiological sensing and data sending modules. Each bedside unit contains a central processor for controlling the flow and format of data from the module and to the central station. The central station includes peripheral display units for selectively displaying data from each of the bedside stations. A central processor controls the flow of data from each bedside station to the peripheral displays and for communicating with each bedside processor. Data links are provided for the analog data from the central stations and data links for serial asynchronous data transmission from the bedside station to the central station and for commands from the central station to the bedside station.

In the prior art remote monitoring of the patient and victims are very difficult and there is no system for transmitting patients related information to other networked hospital for timely diagnosis.

Therefore, there is abundant scope and window of opportunity to design new type of central nursing station with hitherto unavailable features in the prior art. The present invention provides a remote monitored central nursing system for monitoring vital signs of the patient.

OBJECTS OF THE INVENTION

The basic object of the invention is to overcome the disadvantages / drawbacks of the prior art.

Another object of the present invention is to provide a central nursing system for observing patient in geographically dispersed health care location.

Another object of the present invention is to provide a server-browser based unique remote monitoring solution that streams the vital signs of patients from a multi bedded ICU to a centralized location, in real time.

Another object of the present invention is to provide an improved central nursing station for remote monitoring vital sign parameters through LAN/ Internet of plurality of patient & displaying the acquired vital signs on a display screen.

Another object of the invention is to provide an outdoor/ field deployable central nursing station with overhead projector & associated display screen to assist the triage of the victims of flood, natural or manmade calamity where the numbers of patients are large & limited resources for saving the life is available.

Yet another object of the invention is to provide a central nursing station which can be carried, man portable, mobile & quickly deployable inside the hospital or outdoors where patients & victims are brought for evidence based triage.

These and other advantages of the present invention will become readily apparent from the following detailed description taken in conjunction with the accompanying drawings.

SUMMARY OF THE INVENTION

The following presents a simplified summary of the invention in order to provide a basic understanding of some aspects of the invention. This summary is not an extensive overview of the present invention. It is not intended to identify the key/critical elements of the invention or to delineate the scope of the invention. Its sole purpose is to present some concept of the invention in a simplified form as a prelude to a more detailed description of the invention presented later.

According to one of the aspects of the present invention, there is provided a central nursing system for remote monitoring the physiological parameters of the patients/victims.

The central nursing system comprises: a remote server for streaming the vital signs of patient from remote area to a central nursing station for monitoring; a patient monitor(s) connected to patient(s) using a cable/ sensor for displaying the physiological parameter(s) of the patient(s)/ victim(s); a network router switch connected to the patient monitor(s) for collecting the physiological parameter(s) of the patient(s)/victim(s) and transmitting the physiological parameter(s) to the central nursing station after multiplexing by using a cable. The central nursing station for remote monitoring of the patients comprising: a projector for displaying non¬confidential information related to patients on a screen; a central processing unit communicating with said projector for displaying said physiological parameter(s) of the patient(s) on said screen (154); a infrared radiation filter for filtering the infrared and heat radiation emitting from the projector on the screen. A public address module connecting to the central nursing station for announcing the instruction related to patient(s)/victim(s) and a workstation system connecting to the central nursing station through a LAN cable for accessing confidential information of the patient(s)/victim(s). The central nursing system provides remote monitoring of the patients by caregiver(s) thereby ensuring timely and accurate diagnosis.

Other aspects, advantages, and salient features of the invention will become apparent to those skilled in the art from the following detailed description, which, taken in conjunction with the annexed drawings, discloses exemplary embodiments of the invention.

BRIEF DESCRIPTION OF THE ACCOMPANYING FIGURES

The above and other aspects, features, and advantages of certain exemplary embodiments of the present invention will be more apparent from the following description taken in conjunction with the accompanying drawings in which:

Figure 1 illustrates overall view of a Central Nurses Station(CNS) invention deployed on open field for evidence based triage, rescue, physiological signal acquisition, decision making for further medical assistance etc.

Figure 2 illustrates another view of the same Central Nurses Station deployed inside the hospital floor with overhead projector & method of information visualization.

Figure 3 illustrates discloses the detailed views of the hardware keyboard on which the patient information is displayed in push button forms.

Figure 4 illustrates details of the patient admitted in hospital.

Figure 5 illustrates two cases for 30 days trend storage.

Figure 6 illustrates a graphical trend on display screen.

Persons skilled in the art will appreciate that elements in the figures are illustrated for simplicity and clarity and may have not been drawn to scale. For example, the dimensions of some of the elements in the figure may be exaggerated relative to other elements to help to improve understanding of various exemplary embodiments of the present disclosure.

Throughout the drawings, it should be noted that like reference numbers are used to depict the same or similar elements, features, and structures.

DETAILED DESCRIPTION OF THE INVENTION

The following description with reference to the accompanying drawings is provided to assist in a comprehensive understanding of exemplary embodiments of the invention as defined by the claims and their equivalents. It includes various specific details to assist in that understanding but these are to be regarded as merely exemplary. Accordingly, those of ordinary skill in the art will recognize that various changes and modifications of the embodiments described herein can be made without departing from the scope and spirit of the invention. In addition, descriptions of well-known functions and constructions are omitted for clarity and conciseness.

It is to be understood that the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to "a component surface" includes reference to one or more of such surfaces.

The Fig 1 discloses a Server-browser based novel remote monitoring solution (100) that streams the vital signs of patients lying on crash cart (116), triage area (112) or from a multi bedded ICU to a centralized nurse station. It allows caregivers to remotely view, in real time, the vital signs of the patients admitted to the ICU through the hospital LAN, or through the internet/Web. The data of the patients is also stored in a centralized server.

The 102 is caregiver/ triage nurse / who are located in a predetermined emergency assembly area 112. The victims (108) without discretion are brought to this area 112 by various transport means. This transport means comprises air ambulance 114, road ambulance 110 with stretcher/crash cart 106 or hand carried or even self-admitted by patient.

These disaster victims (108) are shifted to the crash carts 116,118,120,122,124 according to whether they are neonatal, pediatric, adult, geriatric, male or female etc. The first 60 minutes from the time of injury is called golden hour where they have to be triaged quickly & given further medical assistance. The patient vital sign monitors 136,138,140,142,144 are connected to these patients using interface cables & sensors 126,128,130,132,134. Since the entire system in 100 will be pre deployed and powered on, the physiological signals of the patients/victims will be immediately displayed on the bed side monitors 136,138,140,142,144. Apart from displaying the vital signs, these monitors will also store these vital parameters trend & transmit over the LAN / WAN /Ethernet and the like.

This is done first through network router switch (146)& communicating cable (152). The signals collected from all the monitors 136,138,140,142,144 are digitally multiplexed and sent to the CNS (158). This central nursing station part 158 allows remote monitoring of patients by appropriate specialists thereby ensuring timely and accurate diagnosis. Remote monitoring of real time waveforms such as ECG, Respiration, IBP, Sp02, and digital parameters like HR, NIBP, and Temperature is possible through the LAN, or through the Web.

Each CNS like 158 needs to transfer up to 16 bed real-time waveform and digital parameter data periodically to the requested client viewer via information server using intranet or internet through www.likewise n-number of CNS can be connected to an information server and n-number of clients can be serviced in real time. The net. top polling duplex technology was more suited for real time streaming requirements disclosed in this invention. The number of concurrent clients a single server 180 can maintain are 128 clients.

The part 148 is public address system communicating with CNS 158, computer display monitor 166, customized keyboard 168 & pointing device 170. Since the distance between the triage carts 116,118,120,122,124 & the monitor 166 is substantially large, along with the added ambient noise of 110, 114& the crowd of people gathered near the disclosed invention, the instructions related to patients will be announced through 148.

For the sake of simplicity the 148 is shown as a single speaker but it contains plurality of such electronic hardware comprising speakers with plurality of microphones , plurality of emergency press switches & electronic hardware to generate hooter alarm, interconnected by deploying electrical,fiber cables with CPU of CNS 158.The CPU (central processing unit) of CNS 158 is also communicating with the projector 150 to display the information related to all the 128 patients on the screen 154.Although for simplicity &clarity, the wall projector 150 & the CNS 158 are shown as different units they can be combined together into a single unit& disposed inside a single enclosure.

An infrared radiation filter (164) is used to filter the infrared & heat radiation from the visible light emitted from the projector(150) on the screen (154). This is useful during night time operation of the invention during which air ambulance 114 is used for (MED-EVAC) medical evacuation. The night vision goggles are used by the crew of 114 to locate the patients on 116 and to transport them back to 114 during night time. These goggles use moon light to amplify the ambient images. The patient monitor 136 to 144 with TFT -LCD screen & the projector 150 will emit the infrared radiation which also distorts , blurs the images seen through night vision goggle which is called blooming effect. The filter 164 which removes infrared radiation and attached to the front panel of the 144 is a novel feature in this invention. Instead of using part 164 the projector module 150 can be made to emit images with non-red and non-infrared colors. For
example only green colored images can be displayed on 154. Similarly the day time visibility can be achieved bysubstantially increasing the brightness of 144 or 150.

By way of an example only five monitors 136,138,140,142,144 connected to five patients on the crash carts 116,118,120,122,124 are shown for simplicity. But this invention can monitor up to 128 patients through plurality of CNS part 158 and display the triage vital signs on the screen 154.

The invention also discloses a graphical interface for intensive care units where Intensive care physicians and others who must review information under stress and make decisions based on their understanding of its implications must be able to consider relationships among many variables (integrated tasks) as well as the values of individual variables.

It is known that information that is displayed on a single page or screen (i.e., within eye span) can be processed more effectively and efficiently than information that is spread across several GUI screens or pages. Due to the limits of short-term memory of human brain, the big picture cannot be constructed nor can comparisons be made when information is not presented within eye span.

Information that is preprocessed and then re-expressed in consistent terms that directly address the purpose of its use (e.g., to diagnose medical conditions) can be understood more effectively and efficiently than a collection of raw vital signs that are expressed in unconnected ways. Given the purpose of diagnosis, expressing the various measures using a consistent scale of low-normal-high relieves the caregiver / surgeon from having to make these conversions in his head.

Simultaneous view of multiple ICUs is also possible when the user is referred for patients in multiple ICUs. There may be certain patients in the ICU who need to be assigned a priority status, which means that all doctors cannot have access to their data.

These patients will be demarcated as 'Protected' patients. Accordingly, the doctor 102 in the triage area or field Hospital or inside ICU can be categorized as:

1. Regular Users:
These emergency nurses/paramedical staff/ physicians (102) will be able to access the data of the patients to whom he/she has been assigned to.

2. Power Users:
These doctors (102 / 172) will have uninterrupted access to all the patients in the hospital, even if they are 'Protected'. Only 'Power' users will have access to 'Protected' patients. A user (102/172) may also be assigned as an ICU In charge, in which case, he will have access to all the patients in that ICU, except the 'Protected' patients.By default, all the users like 102 will have a timed out session of 20 minutes. It is possible for concurrent users to access the same patient's (on 116) real time data.

Yet, the Admin (even 172 can play this role) can set a right for certain users so that they have uninterrupted access to 158. Also some users, designated as 'Power' users (Like 172), are by default given uninterrupted access to 158.

The CNS 158 with Central Information server & Database server 180 and remote viewer 192 provides intensive proactive care to the patients in a single hospital, or across several hospitals or between the field hospital shown in Fig 1 and ICU - hospital shown in Fig 2 and by enabling remote access for the doctors to the patients. The CNS 158 with server 180 networks the different locations in which the hospitals are set up to provide specialty care to all the critically ill patients in ICU.

The CNS 158 with server 180 remote monitoring solutions can be deployed on the LAN, or on the Web, or on both, as per the requirements of the Hospital.

The server 180 is connected to plurality of other CNS 158 systems via a 24port switch 178 when the distance between 178 & the other CNS is small and can be connected through LAN. The Server 180 is also connected to the Web via a wireless modem 184 to send SMS messages, alerts and the clips of physiological parameters to the mobile phone of the caregiver.

In the Fig 1, the CNS 158 is shown as connected through hard wired communication cables. But the systems can also be interconnected wirelessly to the patient monitors through 146 which become wireless access points for that configuration.

The part 158- CNS will have two LAN cards disposed inside to the motherboard. In case of wireless configuration, one LAN card will be used to connect the part 158- CNS system to the access point to which the patient monitors will be wirelessly connected. The patient monitors connected to the part 158- CNS systems via the access points will form one network, with a series of IP addresses (e.g.: beginning with 192.168.106). In case the patient monitors are in wired configuration with the 158- CNS, then in place of the access point, there will be a switch. Thus the patient monitors, as well as the 158-CNS to which the monitors are connected, will be connected to a switch through Cat 5e LAN cables 162,176. The switch does not require an IP address. In this case, the patient monitors and the CNS-158 system will form one network, with a series of IP addresses (e.g.: beginning with 192.168.106).

The other LAN connection on the 158- CNS system will be used to connect to the switch that will link all the other CNS in the hospital to the CNS Server 180. Thus, all the other CNS in the Hospital and the Part 180 Server will form a different network. This network will have another series of IP addresses (e.g.: beginning with 192.168.1).

The Server 180 will comprise minimum of three LAN cards disposed inside the enclosure apart from the server-motherboard. The first LAN card 182 will be connected to the switch 178 that links the Server to all the other CNS similar to part 158. This IP address will belong to the 192.168.1 series. The second LAN connection 184 will have an IP address that belongs to the wireless modem or Hospital LAN series, and will cater to the LAN clients within the Hospital. The third LAN /Ethernet card part 188 will be used to connect the Server to a broadband Internet connection 190, through a router or a modem 186. The
Internet Service Provider (ISP) will assign this IP address to the Server 180.

With server part 180 & CNS 158 it is also possible to network hospitals like part 194 in different locations. This requires the hospitals to be networked through leased lines, or through virtual private network. Though leased lines ensure a dedicated connection between the hospital branches, if the distances are too long, they can be expensive. VPN allows a virtual connection to be formed between the two hospitals across the Internet, thereby networking the two locations. However, a VPN(virtual private network) connection comes at the cost of bandwidth, and QoS. Hence it is used only if the locations to be networked are far apart (above 250km).

The part 192 is a remote viewer apparatus located substantially away from CNS 158 and is used by the caregiver to access the data from 136,138,140,142,144 or from 158 or from server 180.
Remote Web Viewer used in 192 is a Rich Internet Application based on Silver light software. It has list of features like Multi-bed with one real-time Waveform, Multipara screen with three real-time waveform, Alarm View, Trend View, User Authentication, User Management, CNS Registration and Printing.

Web viewer application in 192 can display the stored waveform and parameter trend data of a bed/patient. It can be accessed from any system that has Internet Explore application, including the mobile devices. There is no separate VPN configuration required, server system requires a fixed IP configuration depending the network, in LAN it is a local IP and in WAN it will be public.

Fig 2 Illustrates another view of the same Central Nurses Station deployed inside the hospital floor with overhead projector & method of information visualization.

Here the entire invention is disposed inside a hospital floor where the carts/trolley/gurneys are replaced by standard hospital beds. The projector module 150 can throw the information on glass partition wall, white walls or hanging screens, so that the caregivers as well as layman 206 can see the information from Omni direction. This is one of the novel features of this invention.

The patients will be lying on the bedsl 16, 118 located inside the ICU 204 or monitoring ward. These patients will be monitored using interface cables and sensors 126, 128. These are intern connected to multi-parameter vital sign monitors like 136, 138, 140,142 etc. This ICU ward 204 is covered with glass wall partitions. The central nurse station monitor 158 will be outside this partitioned hall facing the outer side of the glass wall. By way of an example only two patients and four monitors are shown. This invention is scalable and up to 128 patients can be monitored simultaneously and the details can be displayed on the screen 202 using CNS 158 and integrated overhead LCD projector 150.

The 158& 150 are actually disposed in a single enclosure and are hanged from the ceiling of the hospital floor to save the considerable space which is also a novel feature. The information related to these 128 patients will be thrown on the semitransparent glass wall partition. With this the nurse 206 can see the vital sign information related to all the 128 patients and at the same time can directly see through the glass wall the activities of the patient. At the same time the caregiver 206 stationed inside the ICU, attending the patients can also see the backside of the glass wall partition on which the vital signs of all the 128 patients which is 156 is displayed . In case of emergency which is indicated by the highlighting the numerical & waveform information of particular patient, the caregiver can come out of that particular ICU 204 and enter another ICU where the critical patient is lying.

The highlighting physiological parameters comprises flashing, blinking, zooming, change in color, change in background color of the waveform & numerical values.

Fig 3 discloses the detailed views of the screen 154 &156 on which the patient information is displayed in various forms.The reader of this invention will appreciate that there will be at least two displays in this invention. The first one is Part 166 which is LCD / CRT/LED/ PLASMA monitor near the vicinity of the head nurse 172 who is monitoring the entire site where this invention is installed. This monitor will display confidential information which is supposed to be viewed by the authorized persons. The said information comprises of secure login, Reviewing & adding comments on patient's status, triage decision taken and the like.

The overhead projector part 150 in cooperation with Screen 154 is second display which contains non-confidential information comprising status of all the 128 numbers of patients displayed on first screen 166, the status of all the physiological signals of individual patients selected by 172 , on second screen , the real time streaming of selected waveforms of the selected patient ( on litter/crash cart) like 116, the final triage decision , the address & route map of the suitable hospital where the patient has to be taken , the emergency medication to be given to 116 , the list of medications to be carried along with the patient 116, the subsequent operations to be carried on the patient once he/she reached the destination hospital by 110 or 114.

In addition the subtitle information can also displayed simultaneously on 154 when the public announcement about evacuation of patients to be made through 148. This is also novel benefit of the invention where the central caregiver 172 can be able to display the public broadcast message using monitor display 166, keyboard 168, pointing device 170.There can be additional devices like telephones, hooter alarms, GPS locators to assist the central nurse 172 placed on table 174 & communicating with 166 & 158.

The information on 154 and 156 comprises digital / numerical values of the vital signs, physiological parameters, real time waveforms of the physiological signals, visual alarm /bell symbols, date , time , the upper & lower physiological parameter and the like. The novel feature of this invention is the glyph based coded information or symbolic representation of the patient information which can be understood only by the trained caregiver although the public & passerby standing near the 154 & 156 can see the same information.

The following are the push buttons on custom designed hardware keyboard 168 or touch screen icons on the display screen 166 which are actuated to do further activities related to patients wellbeing.

Push button 302 "Secure Login": Each user like 102, including the administrator 172, has a secure login to the CNS-158. In case any user forgets his/her password, the 172 with Administrator role has the right to reset the password.

Push Button 304 "No Time Out option": All users like 102 & 172 by default have a timed out access of 30 minutes to their session to prevent the patient information falling in wrong hand. After this duration, the user needs to sign in again. Users may also be given uninterrupted access. The Admin can set this right for the user. Then, unless the user manually logs off, his/her session will not expire.

Push Button 306 "Patient Security": The care giver 102/doctors 172 can access the patient's data only if he has been referred to that patient. Apart from the referred doctors, the ICU In Charges will have access to the patients admitted to their ICUs. Certain high profile patients maybe set as 'Protected' while the patient is admitted. In that case, no doctor assignment is possible for the patient. The details of the patient will not be displayed even to the ICU In Charges. Thus, no doctor can access the patient, except a 'Power' user. All 'Power' users will have access to all the patients in the Hospital.

Push Button 308 Login:This button is pressed to login & see the details of all the users, including the Admin, will be logged in 158.

Push Button 310 "Remote Users Status": The Admin 172 can monitor the number of remote users at any point of time. Thus, the Admin will have a control if the number of users reaches the maximum limit (based on the number of licenses procured).

Push Button 312 Real Time Streaming: The doctors can view the patients according to the triage site, field hospital or ICU, or as a list. The list will contain details of the patients such as the status of the patient (Triaged/Admitted/ Transferred to hospital using MEDEVAC or CASE EVAC/ Discharged), and the other doctors referred to the same patient.

Push Button 314: Selecting an ICU 204, from the list of ICUs, will open the multi-bed view of the ICU. Selecting a particular patient (through any of the views) will open the multi-para screen of that patient. Three waveforms will be streamed (these waveforms will be selected from the CNS end). The digital parameters to be displayed can be selected using the 'Select Parameter' option.

Push Button 316 for "Time Synchronization of multiple views": The user 102,172 or 206 has four ways to view the stored data of the patient. The views are Graphical Trend, Tabular Trend, Waveform Review, and Alarm Recall. All the views have an option to set the date for which the data is to be viewed. Once the date is selected, the user can select a particular hour (available in Graphical Trend, Tabular Trend, and Waveform Review). In Graphical and Tabular Trend, four hours of data will be displayed at a time. In Waveform Review, minute wise strips are available for each hour. By default all the views will display the latest trend available.

To provide ease of navigation for the user, all the four views are time synchronized. Thus, if the user selects a particular time in Graphical Trend, and then selects Tabular Trend, then the values for that time will be highlighted in the table. If the user then selects Waveform Review, the particular strip for the selected time will be displayed. If the user selects Alarm Review, then the alarm events around the selected time will be displayed.

Push Button 318 for "Graphical Trend Features": A maximum of six parameters' graphical trend can be displayed. The user can set the parameters. The 'Zoom' option is provided in Graphical Trend. On selecting the 'Zoom' option, tabs for 'Zoom Out' and 'Zoom In' will be provided. By default, the graph will be in maximum zoomed-in condition, that is, it will have four hours of data. On selecting 'Zoom Out', the user will be able to see eight hours of data. Subsequent 'Zoom' selections will enable the user to see 12 hours, 16 hours, 20 hours, and 24 hours of graphical data.

Push Button 320for "Tabular Trend Print": Tabular Trend has an option called 'Print'. The user will be able to set the duration of data for which he needs to take the printout.

Push Button 322 "NIBP Filter": In Tabular Trend it is possible to filter the events for which NIBP (non-invasive blood pressure) readings are present.

Push Button 324 "Alarm Events": A screen called 'Alarm Review' is available that displays the list of alarms for the patient. The date for which the alarms are to be viewed can be selected.

Push Button 326 "Waveform Review": The minute wise strips of three waveforms will be available in Waveform Review. The three waveforms will be the waveforms that are set at the CNS end. There is provided a push button key called 'Sim view' that will display the simultaneous view of all the three waveforms along with the numerical parameters.

Push Button 328 "SMS Alert to the mobile phone": In the event of a red alarm for any patient, the referred doctors for that patient may choose to receive a message on the mobile telephone or tablet or laptop. The SMS format will be as follows: The doctor may be located in super specialty hospital away from location 112 or 204. This is done through 184 - wireless modem.The GSM modem 184 that is required to send an SMS will be installed with the Server 180.

Storage, retrieval of patient data during primary triage, subsequent triage, transportation & admission to hospital etc.

The various patient conditions of 116,118,120,122,124 are listed as below.

(a) URGENT- Emergencies that need to be seen within 120 minutes in order to save Life, Limb, or Eyesight.

(b) URGENT SURGICAL- Emergency cases that need to be evacuated within 60 minutes to the nearest surgical unit.

(c) PRIORTIY- Sick or wounded casualties that need to be evacuated within 120 minutes ( The graphical or tabular trend corresponding to this duration can also be sent to the receiving hospital using 158,180,192,190,194) or their medical condition will deteriorate and become an Urgent

(d) ROUTINE - Sick or wounded casualties requiring evacuation, but whose condition is not expected to deteriorate significantly. They need evacuation in 24 hours.

(e) CONVENIENT - Persons being evacuated for medical convenience rather than necessity. (Example: Minor injury for hands or legs) so that the soldier be evacuated for follow up treatment

In addition to the remote access provided to the doctors, the invention allows the storage of medical information and data related to all the patients admitted in the ICUs across various hospitals electronically in a centralized server 180. This server will store all the vital signs and alarms events of the patients for a predetermined amount of time, by way of an example 30 days. The information also contains the triaged evidence, the next procedures to be followed on the patient , the nearest & suitable hospital where the patient can get platinum 10 minutes or golden 60 minutes emergency care so that the patient on litter/stretcher 116 along with 126 or without can be evacuated using road ambulance 110 or air ambulance 114.

The data that is transferred from the CNS 158 system to the Server 180 is of two kinds. There is the real time data (waveform plus the digital parameters), and there is the trend data. The real time data that is sent from the CNS 158 to server 180 includes both real time waveforms (3 waveforms) and the digital data. In multi-bed mode, the ECG waveform and the corresponding HR for 8 beds are displayed.

The trend data that sent from the CNS 158 to the Server 180 goes in both compressed and uncompressed formats. Both will be in encoded binary format, containing headers/footers. The Admin 172 will be responsible for user management as well as server management. She/he will not be able to access the patient data.

Push Button 330 for "User Management": The Admin can create, edit, and delete users accounts or logins. A maximum of 1000 users can be registered with the Server. The data of the users will be stored in a database. He can also assign powers to specific users.

Push Button 332 "Sever 180 Management": The Admin can register hospitals, and ICUs, and maintain a tab on the status of the ICUs. She/he can assign doctors to an ICU. The Admin will handle the security related issues with the server, such as hacking, Trojans, Viruses, Worms, and Spam, by using the appropriate Firewall, Antivirus, Internet Securities, and creating the necessary backups.

Push Button 334 "Select ICU/Patient": All the tabs will be provided as a list on the left hand side of the main screen. When a tab is selected, the options under that tab will be displayed below the chosen tab. The rest of the list will be pushed down according to the number of options under the chosen tab.

On the top right corner, a Welcome message " Skyview" will be displayed. An option to sign out will also be provided. The 'Select ICU/Patient' tab will provide the user with an option to select a 'CNS List', or select a 'Patient List'.

Push Button 336:CNS List: Selecting the 'CNS List' tab will display information about the patients connected to the ICUs that are assigned to the user. The ICU In charge will also be displayed along with the ICU. On selecting and clicking on a particular patient, the waveforms of that patient will be displayed. The patients who are not accessible to the user will be grayed out on the display 166. The double clicking on the ICU button will also open the multi-bed view of that CNS. If there is a 16 bed ICU, then there will be two boxes with that ICU name that

Displays the patients under beds 1-8 listed in one box, and the patients under beds 9-16 listed in another box.

Push Button 338 -.Patient List: Selecting the 'Patient List'( Example 16,118,120,122,124) tab will display a list of patients for whom that user is referred along with their details such as the patient ID, the first name, last name, Hospital Name, the Doctors referred, CNS ID, Bed ID, Sex, Age, Admit Date, and status (Admitted/Discharged/Transferred).

The patient categories will be color coded.

1. For the 'Regular' users, the 'General' category patients (for whom they have access) will be displayed in white colored text, and the 'Protected' category patients' information will be replaced with red colored asterix.

2. The 'Power' users will be able to view the 'General' category patients as well as the 'Protected' patients' data. The 'Protected' patients will be displayed in red colored text, and the 'General' patients in white colored text

3. If there is a link failure (146,152,162 and the like) between the patient monitor and the CNS, that particular patient's real time view will not be available. There will be no graying out of the patients.

A scroll option will be provided for lists extending one page. An option to directly view the first page or the last page will also be provided. When the patient (116,118,120,122,124) is admitted, the status is displayed as 'Admitted'. Upon discharge, the status changes to 'Discharged'. The date of admission, and discharge/transfer needs to be appended against every patient. All the state changes of the patient need to be listed against every patient.

On re-admission of a patient, a new entry is made in the list of patients, with the status set as 'Admitted'.
:If the patient is transferred to another ICU( like from 112 to 204), then his status will be displayed as 'Transferred'

To select a particular patient from the list, the user will be given an option to search via the Patient Name, Patient ID, Hospital ID, or CNS ID. Double clicking on a patient entry will load the multipara view of that patient.

Push Button 340 forlCU View: Double clicking a particular CNS 158 from the CNS List will display the multi-bed format for the 8 beds of the selected ICU, which includes one waveform (by default ECG) and one numerical parameter (by default HR). In the case of a 16 bed CNS, the user can select the multi-bed format of bed 1-8, or of bed 9-16. On double clicking a particular bed, the screen will display 3 waveforms, which are selected at full disclosure of the CNS. All the numerical parameters available at the CNS end will be available for display.

Push Button 342: Patient View (116, 118,120,122,124 )
Double clicking a particular patient through 'CNS (example 158) List' or through 'Patient List' will display the waveforms and the numerical parameters of the selected patient. Only three waveforms will be displayed at a time. They are the waveforms selected in 'Waveform Review' at the can be reviewed by 172 at 166 only.

The screen will be divided into halves horizontally, with the top half displaying the waveforms (will be occupying the full horizontal length) and the bottom half displaying the numerical parameters. The user will be given options as tabs on the left side of the screen, to view the Trend, Multi parameter, Alarm events, and Waveform review the user will be given the choice to select the desired numerical parameters from the available parameters list by clicking 'Select Parameter'. An option for selecting a default set of parameters will be given. Selecting 'OK' will save the changes, and selecting 'Cancel' will discard the changes.

If the patient is re-admitted within the 30/60/90 day time span, his past data will be retrieved, and attached to the current data (prefixed) automatically. If the user chooses to view the past data then 'Patient View' Tab of that patient will not be accessible. It will be grayed off.In the below figure, two cases have been represented, assuming a 30 day trend storage.

As shown in the fig 5, say Patient 1(116) has been admitted for a span of more than 30 days. Thus the older data will be deleted, and only the latest 30 days data will be available.

As shown in the fig 5, say Patient 2(118) had been in the ICU 4 times. The data of the patient on the first admission has been deleted since it is more than 30 days old. If the 'Archive' option was enabled, it'll be available in the compressed form. The second time he was admitted, only partial data is available. The data that exceeds the 30day framework will be deleted (or archived if the option is enabled). The remaining data, and the data available on the third admission will be prefixed to the present data.

By default, for all the screens (Tabular Trend, Graphical Trend, Waveform Review, and Alarm Review), the current time data will be displayed.

Push Button 344 for accessing GRAPHICAL TREND.The Graphical Trend' screen will display three waveform/numerical trend data of the patient, for the last four hours on 166/154. By default the waveform trend data of ECG, Sp02, and IBP (if available) will be displayed as shown in fig 6.

The screen 166/154 will be vertically divided into half. A maximum of six waveforms/numerical parameters can be displayed on the 'Graphical Trend' screen. These waveforms will appear in the same order as the selections made in the 'Select Parameter' list.

An option for setting the date will be given in 'Graphical Trend'. The dates for which data is available only will be selectable. At a time, maximum two dates can be selected for viewing, and these are highlighted with a different color. Suppose the user selects a date, then that day and the previous day will be displayed separately, and the data of the two days will be available to the user for viewing.

At the bottom of the screen, there will be 24 boxes, representing 24 hours of graphical data, beside the Month, and two dates. The hours for which the graphical data is available will be colored in blue. The boxes representing the hours of graphical data available on the screen will be demarcated using a red outline surrounding the corresponding boxes.

The user may select a particular hour from the 24 boxes, in which case the graphical data for the last four hours; from the selected hour will be displayed. The corresponding boxes will be outlined in red.
For example, if the user selects 25th October, then both 24th and 25th October dates will appear beside the month. The hours for which the data is available are highlighted. The other hours will be inaccessible.

If the user selects an hour beyond the red outline on the right, then the trailing edge of the selection shifts to that hour, and the previous four hours are selected, and the corresponding trend is displayed. If the user selects an hour beyond the red outline on the left, then the starting edge moves to that hour, and the next four hours are selected, and the corresponding trend is displayed. Any selection made within the outline triggers no change. Selection between the two dates is also possible (say 2 hours on 24 and 2 hours on 25th)

There will be an option to select the waveform trend data to be displayed from an available list, using the 'Select Parameter' option. The selected parameters will be displayed in the 'Selected List', and will be removed from the 'Available List'. The parameters can also be removed from the 'Selected' list, and placed on the 'Available' list. Selecting 'OK' will save the changes and display the selected parameters. Selecting 'Cancel' will discard the changes and display the original waveforms

The best resolution will be of one minute. The 'Zoom' option will be provided for graphical trend. On selecting the zoom option, tabs for 'Zoom Out' and 'Zoom In' will be provided. By default, the graph will be in maximum zoomed-in condition, with four hours of data. On selecting 'Zoom Out', the user will be able to see eight hours of data. Subsequent 'Zoom selections will enable the user to see 12 hours, 16 hours, 20 hours, and 24 hours of graphical data. Correspondingly 8/12/16/20/24 hour boxes will be given a red outline. 8 Hours

October 24 25 0 1 2 3 4 5 6 7 8 9 1011 12 13 14 115 16 17 18 19 20 21 22 23 20 hours

october24 25 (12345678910111213 141516171819202l2223

User can use a set of vertical line cursors to move through the trend, to know the values at any point of time. There will be no 'Mark' tab. However, the user will be able to select a point in time on the trend graphs by left-click of the mouse and this will place an inverted arrowhead. This will be used to time-sync with the other trends.

In 'Graphical Trend', the marker can be placed at any point in time. If the user then selects 'Tabular Trend', the tabular trend screen will appear, and the data around that time selected in 'Graphical Trend' will be displayed. If the user selects 'Waveform Review', the particular strip for the selected time will be displayed. If the user selects 'Alarm Review', then the alarm events around the selected time will be displayed. In other words the trend, waveform review, alarm recall will be time synchronized for view. On, going back to the 'Graphical Trend' screen, the marker disappears. The default position of the marker (it may not be displayed as a marker) will be the current time, for the time-sync purpose.

Push Button 346 TABULAR TREND: Printing also possible 'Tabular Trend' screen will display the trend data of the patient in a tabulated manner. The resolution will be fixed to one minute.

To see the past data, the user will be able to scroll upwards. An option for setting the date will be given in 'Tabular Trend'. The dates for which data is available only will be selectable. At a time, maximum two dates can be selected for viewing and these are highlighted with a different color. Suppose the user selects a date, then that day and the previous day will be displayed separately, and the data of the two days will be available to the user for viewing. At the bottom of the screen, there will be 24 boxes, representing 24 hours of tabular trend data, beside the Month, and two dates. The hours for which the data is available will be colored in blue. The boxes representing the hours of tabular data available on the screen will be demarcated using a red outline surrounding the corresponding boxes.

The user may select a particular hour from the 24 boxes, in which case the tabular trend data for four hours, from the selected hour will be displayed. The corresponding boxes will be outlined in red.

For example, if the user selects 25 October, then both 24th and 25th October dates will appear beside the month. The hours for which the data is available are highlighted. The other hours will be inaccessible.

If the user selects an hour beyond the red outline on the right, then the trailing edge of the selection shifts to that hour, and the previous four hours are selected, and the corresponding tabular trend data is displayed. If the user selects an hour beyond the red outline on the left, then the starting edge moves to that hour, and the next four hours are selected, and the corresponding tabular trend data is displayed. Any selection made within the outline triggers no change.

There will be an option to select the parameters to be displayed from an available list, using the 'Select Parameter' option. An option for selecting a default set of parameters will be given. Selecting 'OK' will save the changes, and selecting 'Cancel' will discard the changes.

'NIBP Filter' will be made a separate tab that allows the user to filter the NIBP tabular trend.

'Tabular Trend' will have an option to 'Print'. On selecting 'Print', the user will be asked to set the Start date and time, and the End date and time.

Selecting a particular point in 'Tabular Trend', and then selecting 'Graphical Trend' will display the graphs around that point. Selecting 'Waveform Review' will display the particular strip for the selected time. If the user selects 'Alarm Review', then the alarm events around the selected time will be displayed. In other words the trend, waveform review, alarm recall will be time synchronized for view.

Push Button 348 for Waveform Review: Selecting 'Waveform Review' will display 3 waveforms, one of which is the ECG. There will be an option to display the simultaneous view of all the waveforms along with the numerical parameters. When 'Sim view'is selected, the screenwill display the 3 selected parameter waveforms in the first half same of the screen, and the second half will contain the Waveform Review with 'minute-strips' of ECG/Wave 2/Wave 3. The selected strip will be kept highlighted in a dotted box until another instance in the strip is selected.

By default, the waveform review will display the waveforms of the latest date, the latest hour, and the latest minute. To see the past date, the user will be able to scroll up. An option for setting the date will be given in 'Waveform Review'. The dates for which data is available only will be selectable. At a time, maximum two dates can be selected for viewing, and these are highlighted with a different color
At the bottom of the screen 166, boxes representing the 24 hours in a day will be displayed. The user can access the minute-wise waveform strips of a particular hour in a day. To the minute wise strip, the 'hour' needs to be appended to the minute. The seconds marking '00' will be removed.

If the user has selected a particular strip, and then the user changes the date, the latest waveform strip for that date will be displayed.The area with missing waveform will be displayed in a different color, preferably white. This avoids confusion to the doctor. 'Print' is also provided for 'Waveform Review'.
Selecting a particular point in 'Waveform Review', and then selecting 'Graphical Trend' will display the graphs around that point. Selecting 'Tabular Trend' will display the tabular date around the selected time. If the user selects 'Alarm Review', then the alarm events around the selected time will be displayed. In other words the trend, waveform review, alarm recall will be time synchronized for view. The browser plugin application which contains presentation frame based technology that provides features such as video, vector graphics and animations along with the operating systems is used.

The Presentation framework is used for multi-parameter patient monitoring system for continuous monitoring of the physiological parameters 3/5L,ECG/12L,ECG,RESP,NIBP,2 TEMP, SP02,Co2, 4 IBP, CO/NICO,ST analysis ,arrhythmia detection and interface to thermal recorder , CNS,AGM, USAB storage device,

The real time graphics and waveform drawing on 156 and 202 is drawn using screen design programs, Bidirectional streaming and Presentation Framework applications.

Push Button 350Alarm Review: Selecting 'Alarm Review' displays the list of alarms for the patient. A scroll will be implemented to view all the alarm events for a particular date, instead of page selection.

An option for setting the date will be given in 'Alarm Review'. The dates for which data is available only will be selectable. At a time, maximum two dates can be selected for viewing, and these are highlighted with a different color. There will be no hour wise selection. 'Alarm Filter' will be renamed as 'Select parameter'

'Print' will be provided for 'Alarm Review'. 'User Management' for the user will not be available. In case of any change, a request form duly filled by the user will have to be given to the Admin, who can then edit the changes.

Main Menu:

The Admin will be able to access the following tabs:

1) User Management

2) Server Management

All the tabs will be provided as a list on the left hand side of the main screen. When a tab is selected, the options under that tab will be displayed below the chosen tab. The rest of the list will be pushed down according to the number of options under the chosen tab.

On the top right corner, a message 'Welcome Admin' will be displayed.

Push Button 352: User Management
Selecting User Management tab will display a list containing the details of all the users, such as First name, Last name, email ID, hospital address, mobile number & Login name.

An option to scroll between the pages will be provided if the list exceeds a single page. Option to directly view the first page or the last page will also be provided. Options to add user, edit user, delete user, and reset password will be provided at the top of the screen. The actions will be performed on the selected users from the list.

Add User:
On selecting Add User, a pop up window will open where the details such as First name, Last name, email ID, hospital address, mobile number & Login name. The password will be set to a default password (say pass 1234) for all the users.

The admin 172 will be able to check a box to set the user as 'Power', thereby enabling his rights. By default, the users will be 'Regular'. If the admin sets the user as 'Power' user, a message box will pop-up displaying that the rights of the power user would be assigned to that user. An option clicks OK and Cancel needs to be provided in the message box to do/undo this change. An icon will be provided to indicate the 'Power' users.

The admin will also be able to check a box to provide the user with a 'No Time Out' option, thereby enabling a permanent view of the patient's data for that user. By default, the users will have a 'temporary access', i.e. timed out session view to the patients. Time out will occur every 15minutes. This option will be available for selection only for the regular users. The admin can uncheck this option from the 'Edit user' menu upon the request from the user. For the Power user, this selection will be automatically set to 'No Time out' option, as soon as the 'Power' user option is set

Selecting 'OK' will save the changes and display the list of users. The list will be updated to include the details of the new user. Selecting 'Cancel' will discard the changes, and display the list of users, which was available prior to the change.

Edit User: :Edit User will allow the Admin to edit the information related to the user, such as First name, Last name, email ID, hospital address, mobile number, Login name, 'No Time out' and 'Power' status.

Push Button 354: Server Management on selecting Server management, the options available are: Hardware Status Monitor, CNS Status Monitor, Server Settings, Log, Hospital registration, CNS registration, and Remote Client Status Monitor. These options will be provided as tabs on the left hand side of the screen.

Push Button 356 iorHardware Status Monitor:
Selecting Hardware Monitor will give the user information about all the hardware components, sub-systems, projector, central nursing station (158), LAN, server(180) , patient monitors and other hardware components.

Push Button 358: CNS Status Monitor: Selecting the CNS Monitor tab will display the names of the CNS registered in the server along with the status (connected/disconnected), the CNS IP address, and the ICU In-charges.

Push Button 360:Hospital Registration: This tab will display a list of all hospitals dispersed over a geographical area registered with the server. There will be an option to Add Hospital, Edit Hospital, and Remove Hospital at the top Selecting 'Add Hospital' will open a new window that allows the Admin to enter the Hospital ID, the Hospital name, the address of the hospital, the phone number and fax number of the hospital, along with the contact person & his/her email id. Selecting 'OK' will save the changes, and display the new list of hospitals. The list will be updated to include the details of the new hospital.

Selecting 'Cancel' will discard the changes, and display the original list of hospitals. This information is used to transfer the patient using 104 or 114 to suitable hospital using MEDEVAC or CASEEVAC. The facilities available in hospital like availability can be done.

The arrival of the patient can be informed in advance through 190,192,184and 180 so that time is not wasted for initial setup.

Selecting 'Edit Hospital' will open a new window that allows the Admin to edit the Hospital ID, the Hospital name, the address of the hospital, the phone number and fax number of the hospital, and with the contact person & his/her email id. Selecting 'OK' will save the changes, and display the modified list of hospitals. Selecting 'Cancel' will discard the changes, and display the original list of users.

Push Button 362.CNS Registration:
CNS Registration tab will display a list of all the CNS ( like 158) under a particular Hospital registered with the server, with information regarding CNS ID, CNS IP Address, RT Channel Port, RT Agent Port, Remote Server Port, RT Server port, and the ICU In-Charges. An icon will be provided to indicate the ICU In-Charges. There will be an option to select the Hospital from a drop down menu that will then display the CNS under that Hospital. The facilities available in these listed hospitals comprising operation theatres, vacant beds, trauma center, availability of medical equipment's, medications, surgeons, ambulancesalso can be implemented and accessed by 172. This is useful before transporting the patients by 110 and 114 for further treatment. Otherwise the time is wasted in redirecting 110 and 114 to another hospital.

A scroll option will be provided for lists extending one page. An option to directly view the first page or the last page will also be provided.

An option to Add CNS, Edit CNS, and Remove CNS will be provided at the beginning of the page. These options are active only once the hospital selection is made

Selecting 'Add CNS' will open a new window that allows the Admin to enter the CNS ID, CNS IP Address, RT Channel Port, RT Agent Port, Remote Server Port, and RT Server port. The Admin will also be able to set an In-charge for the ICU from a drop down list of doctors. This can also be left as NIL. The doctors list will be fetched from the database of the added users. If the ICU in charge selected happens to be a 'Power' user, he/she will be eligible to see all the 'General' & 'Protected' patients in that ICU where he/she is assigned as ICU in charge. If the selected ICU-in-charge happens to be 'Regular' user, he/she will be able to see all the 'General' patients in that ICU where he/she is assigned as an ICU-in-charge. He/she will not be able to see the 'protected' patients of that ICU. Multiple ICU In-Charges can be assigned to a single ICU. Selecting 'OK' will save the changes and display the new list of CNSes. The list will be updated to include the details of the new CNS. Selecting 'Cancel' will discard the changes, and display the original list of CNSes

Selecting 'Edit CNS' will open a new window that allows the Admin to edit the CNS ID, CNS IP Address, RT Channel Port, RT Agent Port, Remote Server Port, RT Server port, and the ICU In-charges. Selecting 'OK' will save the changes and display the modified list of CNSesregistered with the selected hospital. Selecting 'Cancel' will discard the changes, and display the original list of CNSes

Selecting 'Remove CNS' will delete the information of the CNS from the server. A dialog box will appear that confirms whether the selected CNS needs to be deleted. On clicking 'OK', the CNS will be deleted, and the modified list of CNS will be displayed. Selecting 'Cancel' will discard the changes, and go back to the screen displaying the list of CNS.

Push Button 364 for Remote Client Status Monitor: The Admin will be able to view the remote users who have logged in at any point of time in a separate window. The details of the time of log in, the name of the user will be displayed against every user.

Push Button 366: Select ICU/Patient: The 'Select ICU/Patient' tab will not be provided for the Admin. . A log will be maintained at the Server end, for the assignment of the doctors to the patient. This assignment will take place at the CNS end.

Patient evacuation tracking form, incident, date time, patient name, disposition to home or transfer to hospital, evacuation triage category ( immediate , delayed, minor , expired), accepting hospital,
Medical record sent, medication sent, family traced/notified, admission location,

PATIENT DISPOSITION DURING A HOSPITAL/FACILITY EVACUATION & PATIENT TRACKING MANAGER

Proper causality classification to ensure that the causalities get picked up in the right order

What the caregiver thinks critical may not be critical compared to another causality in another location with a more severe wound Triage ( immediate classification), requesting medical evacuation ,senior healthcare professional seated at 172 or 192,194 will give second opinion Emergency center triage will enable rapid prioritization of pediatric patients to determine howurgently children require care. Triage scales vary and are designed according to their unique context. Most are based on a list of clinical discriminators; some include individual vital signs, while others include early warning scores or symptom-based decision. When identifying life-threatening conditions in children, individual vital signs are known to be poor predictors. The emergency nurses are known for their ability to detect physiological changes relating to vital signs. Combining various standardized physiological parameters from 136,138,140,142,144into emergency report generated by central nurse station 158 or server 180 will be a
powerful tool in initiating appropriate responses from the initial contact at triage.

The causality classification can be as follows.
Emergency, Very urgent, Urgent, Non-urgent, Disposition, Discharge, Admission,

Referral, Died.

Push Button 368: Archival:

Archival for a patient occurs only if the option has been enabled for the patient at the 158 or 180 end.The archived folders must be demarcated with the following fields -- _ Based on the media space available:

1. The server will prompt the admin to backup the archived/un-archived data (data belonging to the trend storage period; data of the patients belonging to non - archived category) when the media space is 70% occupied.

2. The deletion of archived/un-archived data in server as per FIFO ( first data in is the first data to be out) will be activated once the media space is 90% occupied. If the data of the patient has already been written into a CD, then those folders will be deleted.

If the 'Archive' option has been set at the 158 end, then until the data is archived, no data will be deleted, even if it has crossed the stipulated period of storage (30 days by default, 60/90 days - optional).
The list of all the Archived folders will be available to the Admin (172).

Push Button 370 for setting user powers: Users will be of two types.

1. Regular user:

a. They will be able to view the patient to whom they have been referred / assigned

b. The regular user will not be able to view the data of protected patients.

c. They may be assigned to an ICU by the Admin, which makes them the

In-charge of that ICU. This enables the user to view the vital data of all the 'general' patients connected to the ICU, excluding the 'protected' patients.

2. Power User:

a. The power users typically are the Owners, Deans, CMOs, and Medical Directors.
b. They will have access to all the general, and protected patients.
c. A user is set as a 'Power' user at the time of registration by the Admin.

The users will be able to connect to the 180 server from the local network or from web.

Concurrent users will be able to access the same bed. The users will be prompted for a username & password when he/she connects to server 180. When the user logs into the server for the first time, he/she will be forced to change the password set by the admin. A window will open where the user needs to type the 'Current Password' (default set by the Admin), the 'New Password', and re-enter the new password. On selecting 'Save', the password will be saved, and the user will be asked to log in again with the new password. The password for the user will be alphanumeric, and will contain 8 characters.

A user cannot open two simultaneous sessions using the same login. An error message will have to be displayed to the user when he/she attempts to login two simultaneous sessions using same login id. If a user logins to two sessions from the same IP address, then the previous login will be automatically closed. If the user logins through a different IP then the older session will be closed after 20 minutes.

372 Value Added Services: SMS:

The SMS feature will be implemented as in Skyline55. The SMS will be sent for all red alarms.

The SMS format will be as follows.

MMS:

The MMS feature will follow the same format as SMS, with a 12 second alarm strip (-6 and +6 seconds of the alarm event) in JPEG format.

The Remote service login will be able to enable and disable optional features as per the request of the Hospital. The features that can be configured using this login are:

1. HL7 connectivity to HIS

2. Trend Storage Period: By default this period is 30 days, but the invention is designed such a way that it can be upgraded to 60 days, or 90 days.

3. Concurrent Users: By default only one user can have access to the Server. If more users require access, the Hospital will need to procure additional licenses.

4. Redundant Storage: An additional back up for the data stored on the Server will be provided if required.

5. Redundant Power Supply:

The above disclosed invention in Fig 1 &2&3&4&5&6 isfor two of the embodiments. The same invention can also be suitably modified and made to dispose inside the helicopter 114 for air transportation / casualty evacuation of large numbers of patients from the disaster site, triage area or field hospital to the super specialty hospitals as suggested by the 158 & 166. The information of patients is carried either inside the bed side monitor 126 along with patients or it will reach the designated hospital through 176, 180,186,192 & 190.

The present invention should not be deemed limited to the disclosed embodiment however as those of ordinary skill in the art can readily adapt the teaching of the present invention to create other embodiment and applications.

One such modification will be drawing DC power from aircraft 400 Hz power system & powering the entire invention using DC-AC inverters or DC-DC converter power supplies. Another modification is using rugged components & parts passed for air-worthiness. Similarly if the road ambulance 110 is substantially big then the entire invention described in Part 100 can be disposed inside the 110 to monitor plurality of patients.

1. Concurrent users can remotely access the same patient's real time data.

2. Every user has a dedicated and a secure, password protected login through which he/she is able to view all the patients to whom he/she has been referred.

3. Continuous monitoring by appropriate specialists allows timely and accurate diagnosis.

4. This data of up to 16 beds can be streamed from the ICU.

6. The data of the patient can be retrieved for review at a later stage.

7. The stored alarm events of the patient can be viewed as a list, and selecting a particular entry will display the corresponding waveform.

8. SMS Alerts is sent to a doctor in the event of a red alarm occurring for a particular patient to whom the doctor is referred.

9. The trend data of the patient is stored for a period of 30 days.

10. HL7 protocol type connectivity to HIS (Hospital Information System) is provided if required.

WE CLAIM

1. A central nursing system(CNS) for remote monitoring a physiological parameter(s) of the patient(s)/victim(s), said central nursing system comprising:

A remote server (100) for streaming the vital signs of patient from remote area to a central nursing station (158) for monitoring;

a patient monitor(s) or plurality of monitors (136, 138, 140, 142, 144)connected to patient(s) using a plurality of cable/sensor (126, 128, 130, 132, 134)for displaying the physiological parameter(s) of the patient(s)/ victim(s);

a network router switch (146) connected to said patient monitor(s) (136, 138, 140, 142, 144) for collecting said physiological parameter(s) of the patient(s)/victim(s) and transmitting said physiological parameter(s) to said central nursing station(158)after multiplexing;

wherein said central nursing station (158) for remote monitoring of the patients comprising:

a projector for displaying a non-confidential information related to patients on a screen (154);

a central processing unit communicating with said projector for displaying said physiological parameter(s) of the patient(s)on said screen(154);

a infrared radiation filter(164) for filtering the infrared and heat radiation emitting from said projector (150) on said screen (154). a public address module(148) connecting to said central nursing station(158) for announcing the instruction related to patient(s)/victim(s); a workstation system connecting to said central nursing station through a LAN cable (162) for accessing a confidential information of the patient(s)/victim(s);

wherein said central nursing system provides remote monitoring of the patients by caregiver(s) thereby ensuring timely and accurate diagnosis.

2. The system as claimed in claim 1, further comprising a central information server (180) connected to plurality of said central nursing station(s) using a switch (178) in a hospital or across other networked hospital(s) (194) through local area network, wide area network for transmitting the physiological parameter(s) of the patient.

3. The system as claimed in claim 2, wherein said central information server(180) comprising
a first LAN card for connecting said server (180) to said plurality of central nursing station(s) using said switch (178);

a second LAN card connected to a wireless modem(184) for providing information of the patient(s) using Local area network within a hospital;

a third LAN/Ethernet card connected to a router/modem (186) for providing information of the patient(s) using wide area network to the network hospital(s).

4. The system as claimed in claim 1, further comprising a remote viewer apparatus(192) for accessing information of the patient(s)/ victim(s) by the caregiver(s) from said patient monitor(s) or from said central nursing station(158) or from said central information server(180).

5. The system as claimed in claim 1, wherein said workstation system comprising a monitor (166), a keyboard (168), a pointing device (170) for accessing said confidential information of the patient.

6. The system as claimed in claim 5, wherein said confidential information is selected from a group comprises a secure login, reviewing, adding comments on patient's status, triage decision taken and the like.

7. The system as claimed in claim 1, wherein local area network, internet/web is being used for streaming of vital signs of patient by said server browser (100).

8. The system as claimed in claim 1, wherein said patient monitor(s) storing the vital parameters of the patient(s) and transmitting through local area network, wide area network, Ethernet and the like to said central nursing station.

9. The system as claimed in claim 1, wherein said public address module is selected from a group of single speaker, speakers with plurality of microphones, plurality of emergency press switches, hooter alarms and the like.

10. The system as claimed in claim 1, wherein said central nursing system is optionally set up in a transport means for monitoring the patient(s)/ victim(s) during transportation to the hospital.

11. The system as claimed in claim 10, wherein said transport means is selected from a group air ambulance, road ambulance and the like.

12. The system as claimed in claim 1, wherein said screen (154) displaying a non confidential information comprising physiological parameter(s), triage result, emergency nurse resource allocation, patient alarm indication.

13. The system as claimed in claim 1, wherein said screen (154) is selected from the group comprises a glass partition wall, white walls, a hanging screen(s) and the like.

14. The system as claimed in claim 4, wherein said apparatus (192) storing and displaying a waveform and a parameter trend data of the patient(s)/victim(s).

15. The system as claimed in claim 14, wherein said waveform and parameter trend data is selected from a group comprises a multi-bed with one real-time waveform, multipara screen with three real-time waveform, alarm view, Trend View, User Authentication, User Management, CNS Registration and Printing.

16. The system as claimed preceding claims, wherein said physiological parameter(s) isECG, Respiration, IBP, Sp02, Heart Rate, NIBP,Etco2, and Temperature and the like.

17. The system as claimed in claim 1, wherein said infrared filter (164) attached to front panel of said screen and said patient monitor (144).

18. The system as claimed in any of the preceding claims adapted to be used in triage of patients, giving a paper printout of decision to send patient for further treatment to recommended hospitals, selecting the particular hospital(194) for the availability of treatment depending upon the facility, availability of surgeons & equipment and sending the information in advance to the selected hospital so that the patient is admitted substantially lesser time without waiting for the patient data.