JP2004054375A - Medical record management system and medical record management device in its medical record management system and its program and medical record sheet - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To simplify data management and retrieval or the like even when paper medical records are used. <P>SOLUTION: This medical record management system is provided with an electronic pen for acquiring data corresponding to entry contents by optically reading dot patterns from a medical record sheet on which predetermined dot patterns are printed, and for transmitting the data by radio communication and a medical record management device for receiving and managing the transmitted data. The medical record management device is provided with an entry data registering means for registering the entry data in the database at receiving the entry data acquired and transmitted by the electronic pen, and for deciding whether or not the entry data corresponding to additional entry data are registered in the database at receiving additional entry data acquired and transmitted by the electronic pen, and an additional entry data registering means for registering the additional entry data in the database corresponding to the entry data at deciding that the entry data corresponding to the additional entry data are registered in the database. <P>COPYRIGHT: (C)2004,JPO

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to the technical field of a chart management system and method for digitizing and managing data written in a chart created by a medical institution or the like.
[0002]
[Prior art]
Conventionally, many proposals have been made on input support for doctors as this type of system. For example, Japanese Patent Application Laid-Open No. 2001-84317 discloses a method and a system for digitizing medical records. In the method and the system of the electronic chart processing, the chart form is displayed on the pen tablet as the input screen, and the image of the previous chart is displayed as the reference screen, and the handwritten input by the stylus pen is enabled on the chart form. . The contents handwritten on the chart form are registered as text data and image (image) data in a file in the recording means.
[0003]
[Problems to be solved by the invention]
As described above, the authenticity of the data is ensured by recording the content input by handwriting as image data. Furthermore, by registering the contents input by handwriting as text data, data management and data retrieval are facilitated, and data analysis is also facilitated.
[0004]
However, most doctors have conventionally used paper charts, and are accustomed to writing diagnostic results and the like on paper charts using pens and the like. For this reason, it is easier and faster for a doctor to use a pen or the like to write a diagnosis result or the like on a paper chart than to manually input a diagnosis result or the like on a pen tablet using a stylus pen. It is clear that they are superior in terms of gender. In addition, a paper chart may be more convenient to carry around.
[0005]
The present invention has been made in view of the above points, and even in the case where a paper chart is used, a chart management system capable of facilitating data management and retrieval, and a chart management in the chart management system. It is an object to provide an apparatus and a chart management processing program.
[0006]
[Means for Solving the Problems]
In one aspect of the present invention, by reading the dot pattern optically from a chart sheet on which a predetermined dot pattern is printed, data corresponding to the content written on the chart sheet is obtained, and the data is transmitted by wireless communication. A medical chart management system comprising: an electronic pen to be transmitted; and the medical chart management device that receives and manages the transmitted data, wherein the medical chart management device includes an entry corresponding to the content written on the medical chart sheet. Entry data registering means for registering the entry data in a database when the entry data acquired and transmitted by the electronic pen is received, and an addition corresponding to the content additionally entered in the chart sheet When the additional entry data received and transmitted by the electronic pen is received. A registration judging means for judging whether or not entry data corresponding to the additional entry data is registered in the database; and when it is judged that entry data corresponding to the additional entry data is registered, the entry Additional entry data registration means for registering the additional entry data in the database in association with data.
[0007]
According to the chart management system, the contents sequentially entered in a certain chart sheet at a time are automatically associated with each other and registered in the database. Therefore, even when a paper chart is used, data management, Searching and the like can be facilitated. In addition, since the doctor can write the medical record and the like on the paper medical record in the same manner as in the related art without being conscious of the data input by himself, the speed of the medical examination and the like can be maintained.
[0008]
In the chart management system, the chart management device further includes a data creation unit that creates image data and / or text data representing the content written on the chart sheet based on the received entry data, The entry data registration unit registers the created image data and / or text data in the database in association with the received entry data. In addition, the medical record management apparatus further includes a data creating unit that creates image data and / or text data representing the content of the additional entry on the medical chart sheet based on the received additional entry data. The data registration unit registers the created image data and / or text data in the database in association with the received additional entry data. Therefore, the doctor can check the contents of the autograph that he has previously entered on the chart sheet.
[0009]
In the chart management system, the entry data registration unit registers identification information for identifying the chart sheet in association with the entry data in the database together with the entry data.
[0010]
In the chart management system, the chart management device further includes a data presentation unit that presents the data registered in the database based on the identification information input by the identification information input device. Therefore, a doctor or the like can confirm a past medical record registered in the database based on the identification information. Here, the chart management system may further include an identification information input device for inputting the identification information. Further, the identification information input device may read and input the identification information from a recording medium on which the identification information is recorded. Further, the recording medium may be a card type recording medium.
[0011]
In the chart management system, the chart sheet is provided with a column for entering the identification information, and the chart management device is identification data corresponding to the identification information entered in the column, When the identification data acquired and transmitted by the electronic pen is received, an identification information recognition unit that recognizes the identification information based on the identification data may be further provided.
[0012]
In the medical record management system, the registration determination unit may determine whether entry data corresponding to the additional entry data is registered in the database based on the identification information.
[0013]
The chart management system may further include a terminal device that receives the data acquired and transmitted by the electronic pen and transmits the data to the chart management apparatus.
[0014]
According to another aspect of the present invention, a chart paper for an electronic pen written by an electronic pen including an ink pen unit and a reading unit that optically reads a dot pattern is a dot pattern that is optically readable by the reading unit. Area, formed on the dot pattern area, has a medical information writing area for writing medical information, the dot pattern in the medical information writing area is position information in the medical information writing area and Corresponding. The medical treatment information includes information such as entry information for a medical treatment site such as an affected part or an organ of a human body, a medical examination record, and contents of medication. In addition, the term medical chart paper includes various types of paper for entering information related to diagnosis, examination, and the like in hospitals and clinics.
[0015]
According to the above chart sheet, when a doctor or the like writes a figure or character related to the medical information in the medical information input area, the reading unit of the electronic pen acquires the dot pattern of the writing position, and the written contents are converted into data. Can be obtained. Therefore, a figure, a character, or the like written on a medical chart sheet by a doctor or the like can be acquired as data using the electronic pen.
[0016]
The chart sheet is formed on the dot pattern area, and further includes a medical treatment part illustrated area indicating the shape of the medical treatment part. The dot pattern in the medical treatment part illustrated area is located in the medical treatment part illustrated area. It may be configured so as to be associated with information. Further, the medical chart sheet further includes a medical treatment part illustrated area formed on the dot pattern area and indicating a shape of the medical treatment part, and the dot pattern in the medical treatment part illustrated area is assigned to each medical treatment part. It can also be configured as described. Thus, when a doctor or the like makes a figure, character, or other entry with a digital pen in a region where a medical treatment site such as an affected part of a human body is illustrated, the electronic pen can acquire data indicating the entry site. The medical treatment site here includes the whole body or a specific site, an organ, or the like to be examined, such as a human or an animal.
[0017]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, preferred embodiments of the present invention will be described with reference to the drawings.
[0018]
[Overall configuration of chart management system]
First, an overall configuration of a chart management system according to an embodiment of the present invention will be described. FIG. 1 is a diagram showing an example of the overall configuration of a chart management system. As shown in FIG. 1, the medical chart management system 1 is installed in an electronic pen 10 used by a doctor or the like, a terminal device 25 installed in a reception and examination room of a hospital, a medical chart management device 27, a pharmacy of a hospital, and the like. And a terminal device 28.
[0019]
The terminal device 25, the chart management device 27, and the terminal device 28 are mutually connected via a network 29 such as a LAN (Local Area Network), so that data communication is possible.
[0020]
As shown in FIG. 1, the electronic pen 10 is used in combination with a chart paper 20 on which a predetermined dot pattern is printed. The electronic pen 10 is a pen-type input device called a digital pen or the like, and a typical example thereof is an “Anot pen” developed by Anoto of Sweden. The electronic pen 10 has a pen tip 17 similar to a normal ink pen, and a doctor or the like writes characters or the like on the chart paper 20 in the same manner as a normal ink pen. The electronic pen 10 and the terminal device 25 each include a communication unit that supports Bluetooth, which is a known short-range wireless communication standard, and can perform data communication with each other.
[0021]
Next, the configuration and function of each component of the chart management system 1 will be described.
[0022]
[Electronic pen]
First, the electronic pen 10 will be described. FIG. 2 is a functional block diagram showing the structure of the electronic pen 10. As shown in FIG. 2, the electronic pen 10 includes a processor 11, a memory 12, a Bluetooth transceiver 13, which is a Bluetooth compatible communication unit, a battery 14, an infrared LED 15, a camera 16, and a pressure sensor 18 therein. The electronic pen 10 has an ink cartridge (not shown) as a component similar to a normal ink pen.
[0023]
The electronic pen 10 does not convert the locus of the ink drawn on the chart paper 20 by the pen tip portion 17 into data, but converts the locus coordinates of the movement of the electronic pen 10 on the chart paper 20 into data. While the infrared LED 15 illuminates the vicinity of the pen tip 17 on the chart paper 20, the camera 16 reads the dot pattern printed on the chart paper 20 and converts it into data. That is, the electronic pen 10 can acquire a stroke generated by moving the electronic pen 10 by a doctor or the like on the chart paper 20 as image data or vector data.
[0024]
The pressure sensor 18 detects the pressure applied to the pen tip portion 17 when a doctor or the like writes a character or the like on a chart sheet with the electronic pen 10, that is, the writing pressure, and supplies the pen pressure to the processor 11. The processor 11 switches on / off the infrared LED 15 and the camera 16 based on the pen pressure data provided from the pressure sensor 18. That is, when a doctor or the like writes (writes) a character or the like on the chart paper 20 with the electronic pen 10, pen pressure is applied to the pen tip portion 17. Therefore, when the writing pressure equal to or more than the predetermined value is detected, it is determined that the doctor or the like has started writing, and the infrared LED 15 and the camera 16 are operated.
[0025]
The camera 16 reads a dot pattern on the chart paper 20 and supplies the pattern data to the processor 11. The processor 11 calculates X / Y coordinates on the chart paper 20 from the supplied dot pattern.
[0026]
The processor 11 acquires pen pressure array data and X / Y coordinate data while the doctor or the like makes an entry, and stores the data in the memory 12 in association with a time stamp (time information). Therefore, data (hereinafter, referred to as “entry data”) corresponding to the entry contents of the doctor or the like is stored in the memory 12 in a time series. The capacity of the memory 12 can be, for example, about 1 Mbyte.
[0027]
All acquired data is held in the memory 12 until a transmission instruction is given by a doctor or the like. Then, when a doctor or the like gives a transmission instruction, the Bluetooth transceiver 13 transmits the entry data stored in the memory 12 to the terminal device 25 located within a predetermined distance (for example, 10 m) from the electronic pen 10. Basically, once a transmission instruction is given, the electronic pen 10 transmits all data stored in the memory 12 to the terminal device 25, so that the memory 12 is cleared. Therefore, in order to transmit the same information to the terminal device 25 again after the transmission, the doctor or the like needs to re-enter the chart sheet 20. In this case, a doctor or the like only has to trace characters and the like written on the chart paper 20 with an ink pen.
[0028]
The electronic pen 10 itself does not have a function button such as a send button, and a transmission instruction and other instructions are provided by a doctor or the like checking the dedicated box provided at a predetermined position on the chart paper 20 with the electronic pen 10. Be executed. A transmission instruction is previously associated with the position coordinates of the dedicated box. When the processor 11 receives the position coordinates of the dedicated box, the processor 11 supplies the Bluetooth transceiver 13 with the entry data stored in the memory 12 and sends the entry data to the terminal device 25. Is transmitted. Note that the electronic pen 10 does not have a display, buttons, or the like, but the completion of data transmission can be indicated by vibration of the electronic pen.
[0029]
The battery 14 is for supplying power to each element in the electronic pen 10, and for example, the power of the electronic pen 10 itself can be turned on / off by a cap (not shown) of the electronic pen.
[0030]
As described above, the electronic pen 10 has a function of acquiring coordinate data and writing pressure data corresponding to characters or the like written on the medical chart paper 20 by a doctor or the like and transmitting the data to the nearby terminal device 25. Since the pen tip portion 17 is a normal ink pen, there is a feature that the content described on the chart paper 20 remains as an original original. That is, at the same time as describing the original paper, the contents can be digitized in real time in the form of coordinate data or the like.
[0031]
According to the standard functions of the electronic pen 10, the data obtained by the electronic pen 10 is in principle in the form of coordinate data or vector data, not text data. However, the electronic pen 10 has, as a standard function, a function to convert only alphanumeric characters into text by writing in a dedicated area provided on the chart paper 20. In the terminal device 25 and the like, it is of course possible to obtain text data from the coordinate data and vector data transmitted from the electronic pen 10 using a character recognition application.
[0032]
The electronic pen 10 can hold property information (pen information and pen owner information) on the pen itself and its owner, and can be referred to from an application. As the pen information, a battery level, a pen ID, a pen manufacturer number, a pen software version, a subscription provider ID, and the like can be held. The pen owner information may include nationality, language, time zone, e-mail address, available memory capacity, name, address, fax / telephone number, mobile phone number, and the like.
[0033]
Next, a method of acquiring X / Y data of the content entered by a doctor or the like using an electronic pen will be described. As described above, a predetermined dot pattern is printed on the chart paper 20. The camera 16 of the electronic pen 10 reads a dot pattern on the chart paper 20 instead of reading the locus of ink written on the chart paper 20 by a doctor or the like. Actually, as shown in FIG. 1, the illumination area of the infrared LED 15 and the imaging area of the camera 16 (located in the illumination area) are shifted from the position where the pen tip 17 contacts the chart paper 20.
[0034]
The dot pattern is printed with a special ink containing carbon or the like, and the camera 16 can recognize only the pattern using the special ink. Even if ruled lines and frames are printed on the chart paper with ink (not including carbon) other than the special ink, the electronic pen does not recognize them. Therefore, the chart paper 20 is created by printing input frames, ruled lines, notes, and the like with ink other than the special ink.
[0035]
In the dot pattern, as illustrated in FIG. 3, the position of each dot is associated with data. In the example of FIG. 3, two-bit information of 0 to 3 is displayed by shifting the position of the dot vertically and horizontally from the grid reference position (the intersection of the vertical line and the horizontal line). The position coordinates on the chart paper are determined by the combination of the information thus expressed. As illustrated in FIG. 4A, 36 dots are arranged in a grid within a range of 2 mm in length and width, and an array of data indicated by these dots (FIG. 4B) is displayed on the chart paper. Are associated with the position coordinates. Therefore, when the camera 16 of the electronic pen 10 captures a dot pattern as shown in FIG. 4A, the processor 11 changes the data array shown in FIG. The acquired position coordinates on the chart paper (that is, the position of the dot pattern on the chart paper) corresponding thereto are calculated in real time. Note that the minimum unit for recognizing the dot pattern is 2 mm × 2 mm, and the camera 16 shoots about 100 times per second.
[0036]
Next, the details of the chart paper 20 will be described. FIG. 5 shows an example of the structure of the chart sheet. As shown in the drawing, the chart paper 20 has a dot pattern 32 printed on a backing sheet 30, and a pattern 34 such as a ruled line printed thereon. The backing paper 30 is usually paper, and the dot pattern 32 is printed with a special ink containing carbon as described above. In addition, the design 34 is printed with ordinary ink or the like. The dot pattern and the design may be printed at the same time, or one of them may be printed first.
[0037]
The dot pattern 32 does not overlap in one chart sheet, but basically the same dot pattern is printed on a chart sheet of the same format (unfilled). Therefore, when a doctor or the like fills in a required item at a certain position on the chart sheet with the electronic pen 10, the electronic pen 10 acquires a dot pattern corresponding to the position. Therefore, by using the electronic pen 10, the position of the entry point on the chart paper can be specified.
[0038]
As described above, the same dot pattern is printed on the chart paper of the same format. When a plurality of doctors and the like use the chart paper of the same format, it is necessary to distinguish each chart paper. This distinction can be made by giving identification information (ID) to the electronic data acquired by the electronic pen 10.
[0039]
One specific method for distinguishing the entry data on the chart sheet is that a doctor or the like fills in necessary items on the chart sheet, transmits the entry contents from the electronic pen 10 to the terminal device 25, and then inputs the information to the terminal device 25. This is a method of inputting identification information such as a chart number (identification information given to one chart) by operating a unit. The identification information thus input is associated with the entry data transmitted from the electronic pen 10 to the terminal device 25, and is provided for subsequent processing.
[0040]
Another method for distinguishing entry data on a medical chart sheet is a method in which a doctor or the like inputs the above-described identification information to a medical chart sheet. Specifically, as shown in FIGS. 10 (a) to 10 (c), an identification number input field is provided on a chart sheet, and an identification number input by a doctor or the like is obtained as electronic data, and the entry data and Process in association.
[0041]
FIGS. 10A and 10B show examples of identification information input fields in a case where a doctor or the like inputs identification information such as a chart number by checking a box corresponding to a number to be entered. Show. The method of using the input field shown in FIG. 10C uses a sticker sheet on which bar code data of an identification number such as a chart number is printed in advance on a chart sheet. On this sticker paper, a predetermined dot pattern is printed in advance, and further, a band-shaped pattern with a missing dot pattern is printed. When a doctor or the like inputs a horizontal line in the barcode-shaped portion, the electronic pen 10 detects the dot pattern on the sticker paper. However, since the dot pattern is not printed on the band-shaped pattern portion, FIG. As shown in ()), the data obtained by the electronic pen 10 is missing. Therefore, a barcode pattern is detected from the information of the missing portion, and is associated with a predetermined chart number. A method for inputting identification information using the electronic pen as described above is described in Japanese Patent Application No. 2002-148699.
[0042]
In addition, as a method of issuing an identification number such as a chart number, the following method is used. One method is to issue a unique number as a chart number when the chart management apparatus 27 first receives entry data for a chart sheet. Specifically, in the processing of FIG. 8C described later, the entry data written by the patient or the like on the chart sheet using the electronic pen 10 is transmitted to the chart management apparatus 27 via the terminal device 25. , The chart management device 27 sequentially issues chart numbers. The consulted entry data is stored in association with the issued chart number.
[0043]
Another method is to issue a chart number in advance for each chart sheet and print the chart number on the chart sheet. In this case, in addition to the chart number being printed, the chart sheet is provided with a chart number input field. When filling out the medical chart with necessary items, the patient uses the electronic pen 10 to fill in the chart number printed on the chart sheet in a form such as a numerical value in a chart number input box. Thereby, the entry data on the chart sheet and the chart number are associated with each other.
[0044]
FIG. 6 shows an example of the design 34 on the chart paper 20. As shown in the drawing, the chart sheet 20 is provided with a plurality of entry fields 35 to 40 and a transmission box 41 as a design. Although not clearly shown in FIG. 6, a dot pattern is actually printed on the entire surface of the chart paper 20, and the entry fields 35 to 40 and the transmission box 41 are printed with ordinary ink thereon. Have been. The doctor or the like may use the electronic pen 10 to fill in the required items in each entry box of the chart sheet 20 in the same manner as a conventional chart, without being conscious of the dot pattern.
[0045]
The area on the chart paper 20 can be roughly divided into two types of areas. One is an entry area, which is an area in which the contents entered by the electronic pen 10 are directly handled as information. In the example of FIG. 6, a plurality of entry fields 35 to 40 correspond to this. The entry data in these entry columns 35 to 40 is stored in the memory 12 as described above. For example, in the entry fields 35 to 37, for example, necessary items (reception date, ID (identification information), patient name, etc.) are entered by the patient or hospital staff, and the data corresponding to these items is entered in the memory 12 as entry data. Is stored in Thereafter, medical records and medication contents are entered in the entry columns 38 and 39 by the doctor, and data corresponding to these are stored in the memory 12 as additional entry data. In addition, the doctor marks the diseased part on the shape diagram of the whole body, the chest, and the stomach shown in the entry column 40, and thereby corresponding data (data indicating the diseased part of the whole body, the chest, and the stomach). ) Are stored in the memory 12 as additional entry data.
[0046]
The other of the areas on the chart paper 20 is a functional element, and when a check is entered in the corresponding area with the electronic pen 10, an action, an instruction, etc., which are defined in advance for that area, are executed. It is supposed to. The transmission box 41 in the example of FIG. 6 corresponds to this. The transmission box 41 is used when giving an instruction to transmit the entry data stored in the electronic pen 10 to the nearby terminal device 25 as described above.
[0047]
When a doctor or the like writes a check in the transmission box 41 with the electronic pen 10, the electronic pen 10 reads the dot pattern in the transmission box. The pattern is associated with the transmission instruction, and the processor 11 in the electronic pen 10 issues a transmission command of the entry data stored in the memory 12 to the Bluetooth transceiver 13. As a result, the Bluetooth transceiver 13 transmits the entry data to the terminal device 25 by wireless communication.
[0048]
[Terminal device]
Next, the terminal device 25 will be described. As the terminal device 25, a terminal device such as a PC (Personal computer) including a Bluetooth-compatible communication unit and a communication unit for connecting to the medical record management device 27 via the network 29 is applicable. Note that a portable terminal device such as a mobile phone or a PDA (Personal Digital Assistant) may be applied to the terminal device 25. In this case, the terminal device 25 is connected to the chart management device 27 via a network constructed by a mobile communication network, the Internet, or the like.
[0049]
The entry data transmitted by the Bluetooth transceiver 13 of the electronic pen 10 is received by the communication unit of the terminal device 25. Upon receiving the entry data, the terminal device 25 transmits the entry data to the chart management device 27 via the network 29.
[0050]
The electronic pen 10 may be configured to directly transmit the entry data stored in the memory 12 to the medical record management device 27 without passing through the terminal device 25. In such a case, the chart management device 27 is provided with a Bluetooth-compatible communication unit.
[0051]
[Medical record management device]
Next, the chart management device 27 will be described. FIG. 7 is a functional block diagram showing the structure of the chart management device 27. As shown in FIG. 7, the medical record management device 27 includes a processing unit 271, a storage unit 272, and a communication unit 273 therein.
[0052]
The processing unit 271 is mainly configured by a CPU, and controls the entire chart management device 27 according to a predetermined program. Further, the processing unit 271 functions as an entry data registration unit, an identification information recognition unit, a registration determination unit, an additional entry data registration unit, an image data creation unit, and a data presentation unit according to the chart management processing program stored in the storage unit 272. I do.
[0053]
The storage unit 272 is configured by a recording medium such as a RAM and a hard disk. In the storage unit 272, a chart management database 272a is logically constructed. In the chart management database 272a, the contents entered on the chart sheet 20 (entry data obtained by the electronic pen and transmitted from the terminal device 25) are associated with each chart sheet (that is, each chart number). be registered. That is, the medical record management database 272a stores, for each medical record number, a reception date, an ID (identification information), a patient's name, an address, a telephone number, a date of birth, a medical record, a medication, and the like in association with each other. .
[0054]
The communication unit 273 connects to the network 29 and performs data communication with the terminal device 25 and the terminal device 28.
[0055]
[Operation of the chart management system]
Next, the operation of the chart management system 1 according to the present embodiment will be described. FIG. 8 is a conceptual diagram showing a state in which a medical record or the like is written on the chart paper 20 by the electronic pen 10 in a hospital. FIG. 9 is a flowchart showing the processing of the chart management apparatus 27 in the case of FIG.
[0056]
First, for example, at the reception of the hospital, the electronic pen 10 and the medical chart paper 20 are given to the patient, and entry of necessary items (diagnosis date, ID (identification information), patient name, etc.) is prompted. On the other hand, the patient uses the electronic pen 10 to enter necessary information on the chart sheet 20. That is, the patient enters the consultation date in the consultation date entry field 35 on the chart sheet 20, the ID in the ID entry field 36, and the patient's name, address, telephone number, and date of birth in the patient information entry field 37, respectively. I do. During such an entry, the electronic pen 10 acquires pen pressure array data and X / Y coordinate data as client entry data and stores them in the memory 12 in association with a time stamp (time information). (FIG. 8A). In the ID entry field 36, for example, an identification number unique to the patient, which is described on the patient's examination card, is entered.
[0057]
Next, when the patient completes the entry of necessary items and enters a check in the transmission box 41 with the electronic pen 10, the electronic pen 10 reads the dot pattern in the transmission box 41 and stores the entry data stored in the memory 12. Is transmitted to the terminal device 25 by wireless communication via the Bluetooth transceiver 13 ((b) of FIG. 8).
[0058]
Next, upon receiving the entry data, the terminal device 25 transmits the entry data to the medical record management device 27 via the network 29 ((c) in FIG. 8).
[0059]
Next, in the process of FIG. 9, the chart management device 27 receives the entry data transmitted from the terminal device 25 (step S1). Next, the chart management device 27 registers the received entry data in the chart management database 272a as entry data registration means (step S2). Here, the chart management apparatus 27 recognizes the content (for example, ID (identification information)) written on the chart sheet 20 by character recognition of the received entry data, and associates the chart data with the entry data to make the chart management database 272a. Register with. Further, the chart management device 27 creates image data representing the content entered on the chart sheet 20 based on the received entry data as image data creation means, and associates the image data with the entry data. To the chart management database 272a.
[0060]
Next, the patient enters the examination room A and receives an inquiry and consultation of the doctor A. At this time, a medical chart sheet 20 on which necessary information has been entered by the patient is handed over to the doctor A. The doctor A uses the electronic pen 10 to enter the medical examination result in the medical examination record entry column 38 and the medication content in the medication content entry column 39 on the chart sheet 20. During such an entry (additional entry), the electronic pen 10 acquires the pen pressure array data and the X / Y coordinate data as additional entry data, and associates the pen pressure data with the time stamp (time information) in the memory 12. It is stored ((d) in FIG. 8).
[0061]
Next, when the doctor A finishes the examination of the patient and enters a check in the transmission box 41 with the electronic pen 10, the electronic pen 10 reads the dot pattern in the transmission box 41 and writes the additional pattern stored in the memory 12. The data is transmitted to the terminal device 25 by wireless communication via the Bluetooth transceiver 13 ((e) in FIG. 8).
[0062]
Next, upon receiving the additional entry data, the terminal device 25 transmits the additional entry data to the chart management device 27 via the network 29 ((f) in FIG. 8).
[0063]
Next, in the process of FIG. 9, the chart management device 27 receives the additional entry data transmitted from the terminal device 25 (Step S3).
[0064]
Next, the chart management device 27 determines whether entry data corresponding to the received additional entry data is registered in the chart management database 272a as a registration determination unit (step S4). This is performed using an identification number for each chart sheet, such as the aforementioned chart numbers. That is, using the chart identification information such as the chart number, the chart management apparatus 27 can recognize which chart data is the additional entry data, and thereby, the entry corresponding to the additional entry data. It can be determined whether the data has already been registered. Thereby, for example, even if there are many patients, the chart management device 27 can identify the chart sheet 20 passed to each patient.
[0065]
If it is determined in step S4 that the entry data corresponding to the additional entry data is registered, the chart management device 27 stores the additional entry data in association with the entry data as additional entry data registration means. Is registered in the chart management database 272a (step S5). On the other hand, if it is determined in step S4 that the entry data corresponding to the additional entry data is not registered, the chart management apparatus 27 registers the additional entry data as entry data in the chart management database 272a (step S4). S6). Here, the chart management device 27 recognizes the content written on the chart sheet 20 by character recognition of the additional entry data, and registers the content in the chart management database 272a in association with the additional entry data. Further, the chart management device 27 creates image data representing the content entered on the chart sheet 20 based on the additional entry data as image data creating means, and associates the image data with the additional entry data. To the chart management database 272a.
[0066]
As described above, all the contents entered in a certain chart sheet 20 are registered in the chart management database 272a in association with each other.
[0067]
Next, when the patient enters the next examination room B and receives an inquiry and consultation by the doctor B, the patient B is given a medical chart sheet 20 in which necessary information has been entered by the patient. The doctor B uses the electronic pen 10 to enter the medical examination result in the medical examination record entry column 38 and the medication content in the medication content entry column 39 on the medical chart paper 20. During such an entry (additional entry), the electronic pen 10 acquires the pen pressure array data and the X / Y coordinate data as additional entry data, and associates the pen pressure data with the time stamp (time information) in the memory 12. It is stored ((g) in FIG. 8).
[0068]
Next, when the doctor B finishes examining the patient and enters a check in the transmission box 41 with the electronic pen 10, the electronic pen 10 reads the dot pattern in the transmission box 41 and writes the additional pattern stored in the memory 12. The data is transmitted to the terminal device 25 by wireless communication via the Bluetooth transceiver 13 ((h) in FIG. 8).
[0069]
Next, upon receiving the additional entry data, the terminal device 25 transmits the additional entry data to the chart management device 27 via the network 29 ((i) in FIG. 8).
[0070]
When the transmitted additional entry data is received in this manner, the chart management apparatus 27 executes the processing of steps S4 to S6 shown in FIG. After that, every time the contents of a medical examination are entered in the medical chart form 20 in a medical examination or examination, the contents additionally entered there are registered in the medical record management database 272a in association with the contents already registered. Will be done.
[0071]
During or after the doctor's examination, for example, a pharmacist at a hospital pharmacy inputs a patient ID (identification information) from a keyboard (functioning as an identification information input device) of the terminal device 28 installed there. When a command for requesting the contents of the medication is sent to the chart management apparatus 27 via the network 29, the chart management apparatus 27 serves as a data presenting means, based on the input patient ID, according to the chart management database. The entry data registered in the 272a is presented to the terminal device 28 ((j) in FIG. 8) .More specifically, the chart management device 27 displays the medication content corresponding to the input patient ID in the chart. It is acquired from the management database 272a and transmitted to the terminal device 28 via the network 29. As a result, the terminal device 28 Patient ID and medication contents are displayed on the stomach, the pharmacist saw it, even if not yet received medical record paper 20 is in pharmacy, it is possible to enter the quickly, dispensing act or preparation.
[0072]
In the above example, the patient, the doctor A, and the doctor B fill in necessary information on one chart sheet 20. In this case, there is no problem when the electronic pen 10 is prepared one-to-one with the medical chart paper 20 and moves between the patient and the doctor together with the medical chart paper 20, but the patient, the doctor A, and the doctor B When different electronic pens 10 are used, it is necessary for each person to write an identification number such as a chart number or a patient number on the chart sheet 20 when transmitting entry data. Thereby, the entry data entered by the different electronic pens 10 is associated with the identification number such as the chart number, and can be managed by the chart management apparatus 27.
[0073]
Not only a pharmacist at a pharmacy but also a doctor or the like operating the terminal device 25 connected to the chart management device 27 via the network 29 can input a patient ID from the keyboard and request entry data corresponding thereto. In response to such a request, the chart management device 27 presents the requested entry data to the terminal device 25 as text data after character recognition or image data.
[0074]
In the above example, when the doctor or pharmacist requests the chart management device 27 to present entry data corresponding to the patient ID from the terminal device 25 or the terminal device 28, the patient ID is input from the keyboard. . As another example, the terminal device 25 or the terminal device 28 may be connected to an identification information reading device that reads the patient ID from a recording medium on which the patient ID is recorded and inputs the patient ID. In this case, for example, a patient ID is recorded on a patient's consultation card (magnetic card or IC card) or the like, and a doctor or pharmacist passes the consultation card through an identification information input device so that the patient ID can be obtained from the consultation card. Will be read and input.
[0075]
As described above, according to the above-described embodiment, the contents that are sequentially entered in a certain chart sheet 20 with a time interval are automatically associated and registered in the chart management database 272a. In such a case, data management, search, and the like can be facilitated. This is particularly effective when a wide range of medical examinations and tests are performed by doctors and the like in large medical facilities such as general hospitals.
[0076]
In addition, since the doctor can write the medical record and the like on the paper chart in the same manner as in the related art without being conscious of the input as data, the doctor can maintain the medical examination quickly.
[0077]
In addition, a doctor or the like can easily view past medical records on the display of the terminal device 25 by inputting a patient ID (identification information).
[0078]
Furthermore, since the medical record management database 272a has registered therein image data representing the contents entered on the medical record sheet 20, the doctor checks on the display the contents of the autograph that he / she has previously entered on the medical record sheet 20. be able to. Also, since the contents entered by the doctor etc. on the medical chart paper are registered as image data, not only characters such as comments written by the doctor etc. You can register as.
[0079]
In the above-described embodiment, it is configured to use the chart identification information such as the chart number to determine whether or not the entry data corresponding to the additional entry data is registered in the chart management database 272a. Instead, the chart management apparatus 27 can determine whether or not the entry data corresponding to the additional entry data is registered in the chart management database 272a by using the patient ID by the following method.
[0080]
For example, in FIGS. 8E and 8H, when the doctor finishes the examination of the patient and enters a check in the transmission box 41 with the electronic pen 10, the additional entry data is transmitted to the terminal device 25. Here, the terminal device 25 waits for the input of the patient ID without immediately transmitting the additional entry data to the chart management device 27.
[0081]
When the doctor passes the patient's diagnosis card (magnetic card or IC card) through the identification information reading device connected to the terminal device 25 and reads the patient ID, and inputs the patient ID to the terminal device 25, the terminal device 25 transmits the input patient ID and the additional entry data to the chart management apparatus 27 in association with each other. The doctor may operate the keyboard of the terminal device 25 to input the patient ID. However, if the patient ID is read and input by the identification information reading device, an input error or the like can be prevented. .
[0082]
Next, the chart management device 27 determines whether or not the entry data corresponding to the additional entry data is registered in the chart management database 272a based on the input patient ID as a registration determination unit. That is, in FIG. 8A, since the patient ID entered in the ID entry field 36 on the chart sheet 20 is registered in the chart management database 272a, the chart management apparatus 27 additionally writes the patient ID based on the patient ID. It can be determined whether or not the entry data corresponding to the data is registered in the chart management database 272a.
[0083]
Since the same information as the information registered in the medical chart management database 272a is described on the medical chart paper 20 by ink, if the medical chart paper 20 is left, if any trouble occurs, the medical chart paper 20 20 itself can be used.
[0084]
In addition, a medical examination completion column is provided on the medical chart paper 20, and when a doctor enters a check in the column with the electronic pen 10, information indicating the completion of the medical examination is transmitted to the medical record management device 27 and the terminal device 25 for reception. If so, at the reception, it is possible to quickly start preparations for settlement.
[0085]
In the above description, the same dot pattern is printed on the chart paper of the same format, but if a different dot pattern is printed for each chart paper, By making the entry, the identification information of the chart sheet can be automatically obtained.
[0086]
Further, in the example of the chart sheet shown in FIG. 6, a dot pattern corresponding to the position information in the chart sheet 20 is formed in the entry column 40 showing a medical treatment site such as an affected part. Alternatively, a unique dot pattern can be assigned in advance to each medical treatment site. For example, when the medical treatment site includes the whole body, the chest, the stomach, and the like, a unique dot pattern can be assigned to each. Thus, when a doctor makes an entry at a specific position on a specific medical treatment site, it is possible to acquire data indicating the entry position on the medical treatment site, regardless of the format of the chart sheet.
[0087]
【The invention's effect】
As described above, according to the present invention, the contents sequentially entered in a certain chart sheet with a time interval are automatically associated and registered in the database, so that even when a paper chart is used, , Data management, search, etc., can be facilitated.
[Brief description of the drawings]
FIG. 1 is a diagram illustrating an example of the overall configuration of a chart management system.
FIG. 2 is a functional block diagram showing a structure of an electronic pen.
FIG. 3 is a diagram for explaining a method of expressing information by a dot pattern printed on a chart sheet.
FIG. 4 is a diagram illustrating an example of a dot pattern and information corresponding to the dot pattern.
FIG. 5 is a diagram illustrating an example of the structure of a chart sheet.
FIG. 6 is a diagram showing an example of a design on a chart sheet.
FIG. 7 is a functional block diagram showing the structure of the chart management device.
FIG. 8 is a conceptual diagram showing a case where a medical record or the like is written on a medical chart paper 20 by an electronic pen 10 in a hospital.
FIG. 9 is a flowchart illustrating a process of the chart management apparatus in the case of FIG. 8;
FIG. 10 is a diagram illustrating an example of a method of writing identification information on a chart sheet.
[Explanation of symbols]
1 chart management system
10 Electronic pen
11 processor
12 memory
13 Transceiver
14 Battery
15 LED
16 Camera
17 Pen tip
20 medical chart paper
25 Terminal device
27 Chart management device
28 Terminal device
29 Network

Claims (17)

An electronic pen that optically reads the dot pattern from a chart sheet on which a predetermined dot pattern is printed to obtain data corresponding to the content written on the chart sheet and transmits the data by wireless communication; A chart management system, comprising: a chart management device for receiving and managing the data;
The chart management device,
Entry data registration means for registering the entry data in a database when the entry data corresponding to the contents entered in the chart sheet and the entry data acquired and transmitted by the electronic pen is received,
The additional entry data corresponding to the contents additionally entered in the chart sheet, and when the additional entry data acquired and transmitted by the electronic pen is received, the entry data corresponding to the additional entry data is stored in the database. Registration judging means for judging whether or not it is registered in,
When it is determined that the entry data corresponding to the additional entry data is registered, additional entry data registration means for registering the additional entry data in the database in association with the entry data is provided. And chart management system. The chart management device further includes a data creation unit that creates image data and / or text data representing the content written on the chart sheet based on the received entry data,
The chart management system according to claim 1, wherein the entry data registration unit registers the created image data and / or text data in the database in association with the received entry data. The chart management device further includes a data creating unit that creates image data and / or text data representing the content of the additional entry on the chart sheet based on the received additional entry data,
2. The chart management system according to claim 1, wherein the additional entry data registration unit registers the created image data and / or text data in the database in association with the received additional entry data. 3. . The said entry data registration means registers the identification information for identifying the said medical chart sheet in association with the said entry data with the said entry data in the said database, The claim 1 characterized by the above-mentioned. The chart management system described in 1. The registration judging means judges whether or not entry data corresponding to the additional entry data is registered in the database using identification information acquired and transmitted by the electronic pen. The medical chart management system according to any one of Items 1 to 4. The chart management system according to claim 4, further comprising an identification information input device for inputting the identification information. The chart management system according to claim 6, wherein the identification information input device reads and inputs the identification information from a recording medium on which the identification information is recorded. The chart management system according to claim 7, wherein the recording medium is a card-type recording medium. The chart sheet is provided with a column for entering the identification information,
The medical record management device is an identification data corresponding to the identification information entered in the column, when receiving the identification data acquired and transmitted by the electronic pen, based on the identification data, the identification information The chart management system according to claim 4, further comprising identification information recognizing means for recognizing. The said registration judgment means judges whether the entry data corresponding to the said additional entry data is registered in the said database based on the said identification information, The one of Claim 6 thru | or 10 characterized by the above-mentioned. The chart management system described in 1. 9. The medical record management apparatus according to claim 6, further comprising a data presentation unit that presents the data registered in the database based on the identification information input by the identification information input device. The medical chart management system according to claim 1. The chart management system according to any one of claims 1 to 11, further comprising a terminal device that receives the data acquired and transmitted by the electronic pen and transmits the data to the chart management device. An electronic pen that optically reads the dot pattern from a chart sheet on which a predetermined dot pattern is printed to obtain data corresponding to the content written on the chart sheet and transmits the data by wireless communication; The chart management device for receiving and managing the data, and the chart management device in the chart management system comprising:
Entry data registration means for registering the entry data in a database when receiving the entry data acquired and transmitted by the electronic pen, which is entry data corresponding to the content entered in the chart sheet,
The additional entry data corresponding to the contents additionally entered in the chart sheet, and when the additional entry data acquired and transmitted by the electronic pen is received, the entry data corresponding to the additional entry data is stored in the database. Registration judging means for judging whether or not it is registered in,
When it is determined that the entry data corresponding to the additional entry data is registered, additional entry data registration means for registering the additional entry data in the database in association with the entry data is provided. A chart management device in the chart management system, which is a feature. An electronic pen that optically reads the dot pattern from a chart sheet on which a predetermined dot pattern is printed to obtain data corresponding to the content written on the chart sheet and transmits the data by wireless communication; The chart management device that receives and manages the data, and a computer included in the chart management device in a chart management system including:
Entry data registration means for registering the entry data in a database when the entry data corresponding to the content entered in the medical chart sheet and the entry data acquired and transmitted by the electronic pen is received,
The additional entry data corresponding to the contents additionally entered in the chart sheet, and when the additional entry data acquired and transmitted by the electronic pen is received, the entry data corresponding to the additional entry data is stored in the database. Registration judging means for judging whether or not it is registered in,
When it is determined that the entry data corresponding to the additional entry data is registered, it is made to function as additional entry data registration means for registering the additional entry data in the database in association with the entry data. Characteristic chart management processing program. An electronic pen chart sheet filled with an ink pen unit and an electronic pen including a reading unit that optically reads a dot pattern,
A dot pattern area optically readable by the reading unit;
A medical information writing area for writing medical information formed on the dot pattern area, and the dot pattern in the medical information writing area is associated with position information in the medical information writing area. Medical chart paper characterized by the fact that: The medical device further includes a medical part illustration area formed on the dot pattern area and indicating the shape of the medical part, and the dot pattern in the medical part illustration area is associated with position information in the medical part illustration area. The medical chart paper according to claim 16, wherein the medical chart paper is provided. The medical device further includes a medical part illustrated area formed on the dot pattern area and indicating a shape of the medical part, and the dot pattern in the medical part illustrated area is assigned to each medical part. The medical chart paper according to claim 16.

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