Network for portable patient monitoring devices
Contents
1. 5005319363 United States Patent 11 Patent Number 5 319 363 Welch et al 45 Date of Patent Jun 7 1994 54 NETWORK FOR PORTABLE PATIENT 4 920 339 5 1990 Friend et al 340 825 52 MONITORING DEVICES 5 038 800 8 1991 Oba 5 061 916 10 1991 French et al 340 525 75 Inventors James P Welch Beverly Nathaniel M Sims Wellesley Hills both of OTHER PUBLICATIONS Mass H Schillings B Scharnberg Ruth M Sabean C Th 73 Assignee The General Hospital Corporation Ehlers A New Concept For Computer Assisted Pa Boston Mass tient Monitoring Gottingen Information System For Intensive Care GISI pp 173 176 21 Appl No 932 924 Hewlett Packard HP Component Monitoring System 22 Filed Aug 20 1992 Service Manual Functional Description Section Edi tion 3 Jan 1990 pp iii to iv and 2 27 to 2 32 only Related U S Application Data Fisher Berkeley Corporation MMC 2 Second Genera REA tion Computer Nurse Call 1991 63 EE of Ser No 576 700 Aug 31 1990 aban Fisher Berkeley MMC A computer nurse call that is oneg easy to use 5 ue A pos Primary Examiner Donald J Yusko 52 77 340 825 49 Assistant Examiner Edwin C Holloway III 58 Field of Search 340 825 36 825 49 Attorney Agent or Firm Fish amp Richardson 340 825 17 825 52 286 13 286 14 286 07 57 ABSTRACT 870 11 525 524 364 413 02 413 032. 20113 806 ooz ssam HVINTIIO 9 HOLVTLINJA 101 cor 010 m HOLINOW 51915 vel LOL eL ator HOLINOW SN9IS 100 039 Se313uUlM 980 039 5534009 201 5539007 9 sop HOLINON HOLINON ALLOW 1808 1 eL 2i l en 08 318V L LNSWIOVNVN d Se pa 9 007 91 20 SH ES SS313HlM ib NOILVLSXHOM 09 XYHOML3N 59313 e HOLINOW SNDIS Ne e vat 16 8l x u31V3d3u SS d ogi OL HOLINON 09 SNOIS LIA 09 9L Sheet 4 of 13 5 319 363 June 7 1994 U S Patent 01 91 aag 901 r1 W 4 o 01 AC ZOU lt vo dew 10014 3015039 GN3dSns MOHS Sheet 5 of 13 5 319 363 June 7 1994 0 5 Patent SSI 081 Ge 291 9 Cl GEI 3GOW WHOH3JAVM ESI WREE E 091 891 CHL PS 5005835 081 98 EECH YAYO eet 191 sewer LS 04 99 VAVO 041 E aNadsfs MOHS dV MOHS Sheet 6 of 13 5 319 363 June 7 1994 U S Patent 9 914 JGONN
3. 5 WIISAS AVIdSIC VIVO AVN MOHS 002 US Patent ac i FIG7A ar FIG 7C yf peo JP FIG 7E June 7 1994 Sheet 7 of 13 5 319 363 yee 124 yellow 3 FIG 7B dr 132 red IG 7D U S Patent 7 1994 Sheet 8 of 13 5 319 363 John Smith ALARM MANAGER 250 Param Zei ON eg 145 100 Param Set ON 100 Param Set ON 100 Param 100 Param 100 Param Set ON 100 Param Seil 100 100 Param Set ON 120 100 Param Set ON 8 0 1 100 Param Set ON 100 100 Param Set ON 98 6 0 100 Param Seil ON vetat Set 149 FIG 8 0 5 Patent 7 1994 Sheet 9 of 13 5 319 363 e e el 101 4 F FREEZE 115 FIG 9 U S Patent 7 1994 Sheet 10 of 13 5 319 363 PCD 1 16 LINK 12 NE p 2 ai 240 x e XCVR POG 70 LINK 232 TESTER x 242 E FIG 10 U S Patent June 7 1994 Sheet 11 of 13 5 319 363 WALL LINK 12 16 FIG 11 FIG 12 REPEATER 14 PRIMARY PCD 16 LINKS 12 SECONDARY PCDs 16 FIG 13 June 7 1994 Sheet 12 of 13 5 319 363 U S Patent vi Sls 66654 06 SHOLVIONANNV OL 91 5 539154938 WNIWHA
4. FIG 2 shows one of the transceivers 401 mounted in the ceiling of the hallway near nurses station 26 Display screen 247 of workstation 24 enables the user the health care provider to visualize at a glance the locations of all bedsides at which PCDs 16 have been connected on network 10 and all cellular PCDs 16a being used by ambulating patients via conspicuous readily identifiable icons As discussed below with ref erence to FIGS 4 6 which show two types of displays 5 319 363 7 and several icons generated on screen 247 the icons also indicate the status of all such PCDs 16 16a e g whether a patient s vital signs are within or outside of limits thereby enabling the user to rapidly locate every patient being monitored by a PCD 16 16a on network 10 and determining the patient s condition simply by glancing at screen 24f Network 10 and workstation 24 also enable the user to control the operation of every PCD 16 16a in use on bedside network 10 remotely from workstation 24 without the need for the user to travel to the patient s bedside This capability is facilitated by making screen 2Af an interactive device Oe touchscreen Other interface devices 24e such as a keyboard 54 mouse 56 and tablet 57 provide a comprehensive easy to oper ate user interface for control of PCDs 16 16a and for data entry Additional data entry devices e g track balls magnetic card readers and bar code readers not
5. are closed Link testers 232 232a construct decision arrays that determine their next activity when an impe dance imbalance is sensed For example when a third PCD 16 is added an impedance imbalance is observed by testers 232 and 232a Because link tester 232 has just recently sensed an impedance imbalance Oe when PCD 2 was added it does not immediately react by closing switch 235 Link tester 232a does not have the benefit of this history so it immediately closes switch 235a in the manner discussed above If the imbalance is the result of a PCD being removed from link 12 pseudorandomly chosen time outs preprogrammed into link testers 232 and 232a cause the remaining devices to seek the proper termination point using the sequence discussed above Other Embodiments Referring to FIGS 11 and 12 link terminations 18 may alternatively be made by any suitable technique In the arrangement shown in FIG 11 a pair of terminals 60 605 e g female connectors are provided at wall jack 60 with terminator 18 being mounted to ter minal 60b inside the wall A cable 250 is connected between terminal 60a which receives link 12 from the wall and the network input port of PCD 16 A second cable 252 is then connected between the network output port of monitor 16 and terminal 606 FIG 12 shows yet another alternative technique which requires only one cable 250 and a single wall jack terminal 60 connector 254 tha
6. nected to the network determines such as by impe dance testing whether the cable is already terminated by another device and circuitry for terminating the cable if it has not already been terminated If the cable is already terminated e g by a device that had previ ously been connected to the cable but the termination is improper for the newly added device an impedance imbalance is placed on said cable this causes the previ ously connected device to remove the termination thereby permitting the newly added device to terminate the cable Other links are cellular in nature and adapted to com municate over a wireless transmission medium with 60 65 cellular devices disposed in a predetermined area Mul tiple transceivers are arranged on the link and each transceiver communicates with a device located in a regional cell within the area that is assigned to the trans ceiver Each cellular device transmits messages that identify the device and each transceiver relays mes sages received from a device located in the transceiver s cell and identifies itself as part of the relaying process The cellular location of a device is determined based at 5 319 363 3 least in part on the identity of the transceiver with which the device is communicating The identity of each device connected to the network at each location is tracked based on the messages that the devices transmit A database for stores information that designa
7. shown may be used as well Data sent by PCDs 16 16a to workstation 24 over network 10 is stored in disk drive memory 58 or sent to database 36 for storage The data can also be stored on other media such as an opti cal disk or magnetic tape Referring also to FIG 3 each port 13 of multiport repeater 14 is assigned a unique address 131 13 5 Ports 13 with addresses 131 13 e g 36 ports con nected by links 12 bedsides 62 port address 131 1 is assigned to wireless network CPU 400 and port address 13 n42 is assigned to workstation 24 Consequently port addresses 13 13 uniquely identify every bed 62 serviced by network 10 while port address 13 44 1 designates the wireless subnetwork and port address 13 n 2 identifies workstation 24 Alternatively one or more port addresses 13 13 may be connected by a link 12 to a room in which PCDs are stored when not in use connection of the PCDs to such link in the storage room allows the PCDs to be inventoried via network 10 During operation of multiport repeater 14 repeater CPU 15 and NSF 17 monitor ports 13 to determine whether each is in use This information is available to workstation 24 As shown schematically in FIG 1 the repeater ports 13 connected to workstation 24 and wire less network CPU 400 are always terminated 18 Every PCD 16 that is constructed to operate over an Ethernet and IEEE 802 3 network includes a trans ceiver 70 that is programmed upon manuf
8. 60 His temperature T1 is 101 47 F The displayed data are refreshed with each message received by workstation 24 from the PCD and mes sages are transmitted at a rate that allows waveforms 190 190 to be viewed in real time user controls the operation to any PCD 16 16 displayed in a window 151 159 by clicking on a selected button of that PCD s image For example vital signs monitor image 160 includes a menu 194 of control func tion entries 196 ie sensor alarms display system and freeze that the user can operate via the operator interface of workstation 24 as if the user were selecting the same controls on the PCD s front panel Clicking on any of entries 196 causes either a submenu not shown of additional choices for that entry to appear or causes a window to be displayed that enables the user to manipulate the control function of that entry Records of the data received from the various PCDs 16 16a on network 10 e g snapshots of waveforms 190a 190c and trend data are stored in the worksta tion s disk drive 58 and database 36 for later retrieval Hard copies of data such as waveforms are obtained with a stripchart recorder not shown Other devices such as graphical printers not shown enable the user to 60 65 provide documentation of screen displays and generate reports such as trend plots of several of a patient s vital signs over time Referring to FIG 6 the user ca
9. bedside data terminals The 5 319 363 17 PCDs on secondary network 10 can communicate using any suitable protocol such as the IEEE P1073 MIB medical information bus protocol Referring to FIG 14 other arrangements of network 10 are also possible Network 300 employs a terminal server 302 to provide point to point wiring to multiple bedsides via links 304 that extend from RS232 ports 306 of the server Terminal server 302 is connected to work station 24 via taps 308 on a single Ethernet cable 310 terminated 312 at each end Taps 308 are also used to connect other devices on network 300 to cable 310 Network transceivers 314 316 are interposed between taps 308 and the AUI ports of workstation 24 and termi nal server 302 respectively In operation workstation periodically polls each terminal server port 306 to determine which links 304 are connected to a PCD 16 Links 304 that are not so connected are designated inactive as described above Only messages present on a link 304 determined to be connected to a PCD 16 are recognized by workstation 24 FIG 15 shows a twisted pair 10 base T cable 502 used in place of coaxial cable for a link 12 Twisted pair 502 is connected point to point from repeater 14 to wall jack terminal 60 The cable 500 that connects PCD 16 to terminal 60a is terminated in isolation trans former 501 in the transceiver 503 of the This connection inherently terminates link 12 Repeater 14 FI
10. coaxial cable If link tester 232 determines that link 12 is unterminated it closes switch 234 to insert terminating resistor 236 between the center conductor and shield When an additional PCD 16 such as PCD 2 FIG 10 is connected to already terminated link 12 the link tester 232a in the newly added PCD determines whether link 12 is properly terminated given the lengths of the respective cables 240 242 connected to PCD 1 and PCD 2 For best results the termination should be at the most distant point on the link Thus when link tester 232a determines that link 12 is already terminated it attempts to transmit over link 12 If it observes a so called collision of the message caused by reflec tions on link 12 that are the result of an improperly located terminator link tester 232a closes switch 235a to place an impedance imbalance on link 12 by short circuiting the center conductor to the shield 10 15 20 25 30 35 40 50 60 65 16 Link tester 232 PCD 1 detects the imbalance by sensing collisions of messages that it attempts to trans mit over link 12 and responds by opening switch 234 The resultant change in the link impedance is sensed by link tester 2324 which then closes 234a and opens switch 2350 This places termination 236a properly at the most distant point of link 12 Link testers 232 and 232a store the related times at and sequences in which switches 234 235 234a 235a
11. communicating with a vital signs monitor 16a located within the cell of transceiver 4015 which is located in hallway B of the floor Moreover because network 10 and hence the data in table 80 is accessible via WAN 32 from other comput ers in the hospital the utilization of PCDs 16 16a can be Observed and managed on a hospital wide basis Among other advantages this provides efficient allocation of hospital resources It also enables rapid determination of the locations of all patients in a particular classifica tion e g all patients that are connected to vital signs monitors Security codes can be employed to prevent unauthorized inquirers from obtaining sensitive infor mation about the patients to ensure patient privacy For example the cardiac department may be given an ac cess code that enables them to determine via an inquiry made on the hospital wide information network 34 the locations of all patients whose electrocardiogram activ ity is being monitored with a vital signs monitor PCD but prevents them from obtaining the cardiac data gen erated by the PCDs admitting physicians may be given 20 25 40 45 50 55 60 65 10 an access code that enables them to obtain such cardiac data but only for their own patients Workstation 24 generates numerous displays on screen 24f that allow the user to visualize at a glance the locations of the bedsides that are equipped with PCDs 16 the locations of cell
12. each annunciator 30 responds to the alarm message by causing a tone genera tor 33a to sound an alarm and causing display 335 a rectangular array of LEDs to illuminate a message 35 FIG 2 that identifies the bed at which the alarming PCD is located and the type of alarm For example if the heart rate of the patient in bed B of room 1124 falls outside of preset limits annunciators 30 display the message 11248 LIMIT CPUs 31 prioritize alarm messages from workstation 24 by their type so that messages 35 for simultaneously existing alarms are displayed in order of their seriousness or their occur rence As a result a health care provider can listen and watch for alarms from annunciators 30 while perform ing tasks that take him or her away from nurses station 26 Annunciators 30 are placed strategically throughout the floor e g on the wall above doorways suspended from the ceiling at hallway intersections so that a health care provider can observe and hear at least one annunciator from nearly any location on the floor Bedside network 10 is a local area network LAN that conforms to Ethernet and IEEE Standard 802 3 and forms part of a wide area network WAN 32 in the hospital WAN 32 includes other bedside networks 10 and other types of networks 34 for example a hospital wide information network that allow patient data stored in a shared database 36 to be accessed throughout the hospital All of the networks 1
13. some of said locations are sites on the floor of a building one of said formats including a map of said floor said display device including means for generating at positions on said map that represent said sites symbols that identify the sites at which devices have been connected to said links 29 The system of claim 28 wherein at least some of said devices receive input signals from an external source and include a display for displaying data repre sentative of said input signals and at least one control that a user manipulates to control the operation of said device said format including a window for displaying an image that represents said device display said image including a symbol that represents said con trol 30 The system of claim 29 wherein said processor includes an interface device responsive to commands entered by the user to enable the user to identify the device for which said image is to be displayed 31 The system of claim 30 wherein said interface device includes means for allowing said user to identify said device by selecting one of said symbols on said map 32 The system of claim 17 wherein at least some of said devices receive input signals from an external source determine whether said input signals are within predetermined limits and send messages about said input signals to said processor via said links said system further comprising at least one alarm device responsive to said processor for prod
14. tests and viewing radiology reports to name but a few Work station 24 also includes numerous user interfaces 24e described below and a high resolution display 24 10 facilitate the health care provider s use and operation of bedside network 10 Other workstations 24 not shown may be connected to bedside network 10 to facilitate clinical activities It will be appreciated that often a single nurses sta tion 26 serves several rooms 15 which each include one or more patient beds and that PCDs 16 located in various rooms 15 or PCDs 16a located in the hallways of the floor typically cannot be seen or alarms gener ated by the PCDs heard at the nurses station But as described in detail below bedside network 10 allows the health care provider to both monitor the status of and control the operation of any PCD 16 16a on net work 10 via workstation 24 Bedside network 10 also includes multiple alarm an nunciators 30 connected to the RS232 ports of worksta tion 24 and mounted remotely from the nurses station 26 such as at selected hallway locations throughout the floor As described in detail below when workstation 24 receives a message from a PCD 16 16a that indicates that the PCD is in an alarm condition workstation 24 20 25 30 35 40 45 50 55 60 65 6 besides displaying an indication of the alarm on display 24 5 described in detail below sends an alarm message to annunciators 30 The CPU 31 in
15. 0 34 are connected via standard taps 42 to a common link 40 called a that runs throughout the hospital Spine 40 is a 10 base 5 coaxial cable but any other suitable transmission me dium can alternatively be used Each end of spine 40 is terminated 41 by connecting a 50 ohm impedance de vice between the center conductor 40a and the shield 405 of spine 40 to minimize signal reflections and pro vide a suitable transmission medium for messages sent over spine 40 A bridge router 44 is connected between tap 42 and multiport repeater 14 in bedside network 10 to control the transmission of messages between network 10 and other networks via spine 40 Like the other Ethernet devices on network 10 bridge router 44 implements network supervisory functions 17 FIG 2 shows the physical arrangement of a portion of bedside network 10 on a hospital floor Multiport repeater 14 and bridge router 44 are mounted in an equipment closet 50 for connection to spine 40 Most of the links 12 are wired on a point to point basis to indi vidual bedsides in rooms 15 Rooms with multiple beds receive one link 12 for each bed a private room 15 is shown in FIG 2 The end of each link 12 is made available for connection to a PCD 16 via a modular wall jack 60 located near the patient s bed 62 As discussed cable 19 is connected to wireless net work CPU 400 which is in turn connected by subnet work link 403 to multiple wireless transceivers 401
16. 36 or workstation memory 58 stores among other information records that associate each network ad dress 72 75 77 with a PCD type e g vital signs moni tor ventilator infusion pump etc and serial number thereby enabling workstation 24 to identify the type of PCD from which an incoming message originated sim ply by inspecting the database records Workstation 24 constructs a management table 80 by which it keeps track of the active inactive status of all of the ports 13 and their corresponding locations on the network the network address of each PCD connected to an active port and the identity of each such PCD Thus a user at workstation 24 can easily determine the locations of the bedsides at which PCDs 16 are in use the cells in which wireless PCDs 16a are being used and the identity of each type of monitor being used at each such bedside and in each such cell For example the user can quickly determine that the patient in bed 1101A the bed that corresponds to port address 135 is using a vital signs monitor while the patient in bed 1119A port address 137 is using a vital signs monitor an infusion pump and a ventilator By accessing admit ting or patient census records via hospitalwide infor mation network 34 or by entering patient identifica tion information the user can link patient names with PCDs 16 at specific bed locations Additionally table 80 shows that wireless subnetwork 420 is active and is currently
17. 370 85 1 85 2 85 3 379 25 Multiple devices that are each suitable for use at se lected one of multiple locations are managed using a 56 References Cited network of links that are each assigned to one of the U S PATENT DOCUMENTS locations Each link is selectable between a state in which a device is not using the link and a state in which one or more devices are using the link Links that are in 11038 Sg Ee et al use by the devices are identified and the locations at 4 356 475 10 1982 Neumann et al SE which the devices are used are determined based on the 4 674 085 6 1987 Arangure et al identities of the links that are in use 4 887 260 12 1989 Carden et al 4 916 444 5 1990 King 4 051 522 9 1977 et al 340 717 52 Claims 13 Drawing Sheets 40 41 BEDSIDE NETWORK 10 MULTIPORT REPEATER UNTERMINATED LINKS 118 TO EACH BEDSIDE ONFLOOR NON INVASIVE FUNCTION L 1 1 1 D t 1 H 1 t 1 D NSF invasive PULSE i BP 222222 192007 NURSES STATION 26 12 WIRELESS PATIENT NETWORK ROOM 15 NETWORK VIRTUAL LINK 12 NSF CELL CELLULAR PCD ON AMBULATING PATIENT e 9 Si NO aod HAIX
18. G 1 detects the termination by sensing a balanced impedance on twisted pair cable 502 and responds by designating link 12 as active Disconnection of cable 500 from PCD 16 or wall jack terminal 60a produces an impedance imbalance on twisted pair cable 502 which causes multiport repeater to designate link 12 as unter minated and thus unused Other embodiments are within the scope of the fol lowing claims We claim 1 A system for managing multiple devices each of which selectively operates in one of a normal condition and an alarm condition each one of said devices being portable to allow the device to be operated in any se lected one of a plurality of locations comprising a network that includes a plurality of links each of which is assigned to a predetermined one of said locations each link having a first state in which none of said devices is in electrical communication with said link and a second state in which at least one of said devices is in electrical communication with said link means for placing at least one of said devices in elec trical communication with a selected one of said links that was previously not in electrical commu nication with any of said devices and changing said selected link from said first state to said second state independently of whether said at least one of said devices that is placed in electrical communica tion with said one link is in said normal condition or said alarm condition and me
19. L OL 66654 262 SH NO S3OIA3G H3H10 OL NOILVLSHHOM ve U S Patent June 7 1994 Sheet 13 of 13 5 319 363 TO PORT 13 OF MULTIPORT REPEATER 14 5 319 363 1 NETWORK FOR PORTABLE PATIENT MONITORING DEVICES This is a continuation of application Ser No 07 576 700 filed Aug 31 1990 now abandoned BACKGROUND OF THE INVENTION This invention relates to interconnecting multiple patient care devices to a central location such as a nurses station for observation and control A wide variety of patient care devices PCDs are currently available Examples include vital signs moni tors which measure such parameters as ECG non invasiv and invasive blood pressure pulse oximetry etc ventilators and infusion pumps PCDs typically are not permanently installed beside each bed in every hospital room in the general care areas of the hospital One reason is of course the expense of such an arrange ment but another equally practical reason is that pa tients who are cared for in these areas generally do not require routine use of PCDs Often vital signs monitoring and use of infusion pumps are necessary temporarily for example for a few hours after the patient returns to the room from sur gery This is typically accomplished with portable PCDs brought to the patient s bedside Thus portable PCDs are used in general care areas on an ad hoc basis and it is common for a given PCD t
20. a result continuity of nursing care is maintained The invention also provides central monitoring of numerous vital functions and other patient care activi ties e g ventilation Patients are located easily through the utilization and implementation of standard readily available network hardware and software and standard network management techniques This further 5 20 25 30 35 40 45 50 55 60 65 4 reduces the cost of the system and ensures compatibility with existing and emerging communications devices The PCDs are connected to and disconnected from the network without disrupting the operation of the network or the performance of other PCDs a must in view of the ever changing locations in which the PCDs are used Besides the numerous benefits to the quality of patient care the invention also allows many administration functions involving the PCDs e g inventory control service calls billing for PCD use to be automated Other features and advantages will become apparent from the following description and from the claims DESCRIPTION OF THE PREFERRED EMBODIMENTS We first briefly describe the drawings FIG 1 is a block diagram that shows a network for portable patient care devices according to the inven tion FIG 2 is a partial perspective diagram of an area of hospital floor on which the network has been in stalled FIG 3 is a block diagram and table useful in under standing th
21. a room 15 remains inactive unless and until a PCD 16 is connected to the link s wall jack 60 in such a way as to provide termination 18 for the link For the sake of clarity terminations 18 are shown schematically in FIGS 1 and 3 several alterna tive physical arrangements for providing the termina tions are discussed below Repeater 14 detects that the termination has been made and then designates the link as active This is an often used network management technique to identify and shut down normally ter minated links that because of a fault become unter minated That is in a typical network the links are always terminated and devices are connected to and discon nected from a link via taps that do not disturb the termi nated condition of the link much like the way in which bridge router 44 is connected to spine 40 The inven tion takes advantage of the existing network manage ment capabilities to identify an unterminated link e g link 121 using the unique address of the repeater port e g port 131 to which the link is connected and thereby determine which bedsides have not been con nected to a PCD 16 and hence by exclusion which bedsides are so connected This capability is particu larly important because the topology of network 10 that is the status and identities of the ports 13 that are terminated with PCDs 16 changes constantly as the portable PCDs 16 are brought to the bedsides where they are neede
22. acture with a unique network i e Ethernet address 72 Likewise wireless network CPU 400 is programmed with a unique network address 73 cellular transceivers 401 are each programmed with a unique network address 75 and each cellula PCD 16a is programmed with a unique network address 77 This provides a simple straightforward mechanism by which workstation 24 or database 36 can identify not only the addresses 13 13 42 of the ports 13 and the cellular transceivers 401 that are that are in use and hence the locations of the PCDs 16 and PCDs 16 but also the types eg vital signs monitors ventilators and infusion pumps and serial numbers of PCDs 16 16a that are using net work 10 One benefit of this capability is central hospi tal wide WAN automated control of numerous adminis trative functions concerning the PCDs e g inventory control service calls and billing for PCD use In operation one of the network management tasks of workstation 24 takes advantage of the ability of multi port repeater 14 to determine whether each port 13 is connected to a link 12 that is active Oe in use by PCD or inactive i e unused For each link 12 that is 15 30 35 40 45 wired into a patient s room 15 this determination is made by detecting whether the link 12 is terminated 18 Links 12 that are unterminated e g link 12 connected to port address 131 are determined to be inactive idle A link 12 wired to
23. ans for identifying the links that are in electrical communication with said devices by detecting the links that are in said second state independently of identities of the devices that are in electrical com munication with said links and determining the locations at which devices are in electrical commu nication with said links based on said identifying 2 The system of claim 1 wherein said devices send and receive messages to other devices on the network 20 25 35 40 45 50 55 60 65 18 via said links said means for identifying includes cir cuitry having a plurality of ports each of which is asso ciated with at least one of said links for identifying the ports that are associated with links on which said mes sages appear and determining the locations of said de vices based at least in part on the identification of said ports 3 The system of claim 2 wherein the messages sent by a said device identify said device said means for identi fying associating the identity of said device with the location of said device 4 The system of claim 3 wherein at least one of said links includes a cable having an end disposed at one of said locations said end of said cable being unterminated when said link is in said first state said means for causing including means for terminat ing said end of said cable to change said link to said second state and said means for identifying including circuitry for detectin
24. apidly identify the number and types of devices in use at that location as well as the status of each device If desired the user can also monitor the virtual images of the front panels of the devices A sophisticated user interface allows the user i e a health care provider to control the operation of any device on the network For example alarm limits may be set or modified and alarm conditions may be disabled from the workstation without requiring the user to trave to the device Devices are selected for control using any one of the display formats described above The system also includes multiple alarm annunciators disposed at various locations e g throughout a hospi tal floor for displaying messages that identify devices that enter an alarm condition and sounding alarm tones to warn health care providers of the existence of the alarm The annunciators are also controlled e g to silence the alarm tone from the workstation via the user interface The invention provides a powerful but straightfor ward and inexpensive solution to the problem of cen trally managing the use and control of portable patient care devices PCDs The PCDs are networked without the need to install a PCD at every bedside enabling a hospital to stock relatively few PCDs for a large num ber of beds Because all general care bedsides are avail able for connection to the network there is no need to move the patient to the PCD for close monitoring As
25. ar too low or too high an infusion pump might ex haust its fluid reservoir or detect a downstream occlu sion or the patient s airway pressure as detected by a ventilator may fall outside safe limits When worksta tion 24 detects such an event it changes the icon 102 that corresponds to the patient s bed or cellular location of the PCD to alarm icon 1024 FIG 7D Alarm icon 102d is a red square 132 that flashes 134 e g once per second to warn the user of the existence of an alarm Red square 132 contains a character 135 such as a heart that indicates the type of alarm In addition the virtual image 106 of the front panel of the alarmed PCD 16 16a is automatically displayed in workspace 104 FIG 4 Thus the user in nurses sta tion 26 is immediately notified of the alarm condition even if the patient is in a remote room on the floor and can observe the status of the alarmed PCD and if neces sary control the PCD from his or her position at work station 24 Workstation 24 also sends a message to hall way annunciators 30 FIG 1 causing them to sound an alarm and display a message identifying the bed at which the alarm is occurring and the type of alarm The effect is to convert an alarm generated locally by a PCD which emits an alarm tone that may not be heard e g outside of the immediate vicinity of the patient s room into a global alarm that can be seen and heard practi cally anywhere on the floor In noise se
26. ast one of said de vices that is placed in electrical communication 15 20 50 22 with said one link is in said normal condition or said alarm condition and identifying the link that are in electrical communica tion with said devices by detecting the links that are in said second state independently of identities of the devices that are in electrical communication with said links and determining the locations at which devices are in electrical communication with said links based on said identifying 47 The method of claim 46 wherein at least one of said links includes a cable having an end disposed at one of said locations said step of causing at least one of said devices to use a selected one of said links including terminating said end of said cable to change said link to said second state and said identifying including detecting that said end of said cable has been terminated as a basis for deter mining that said link is being used 48 The method of claim 47 wherein said step of con necting includes using circuitry associated with said one device to determine if said link has already been changed to said second state by another one of said devices that was previously connected to said end of said cable at said location and that terminates said cable and terminating said end of said cable unless said cable has already been changed to said second state 49 The method of claim 48 wherein said determining inclu
27. d A wireless cellular transceiver 402 in each transceiver 401 transmits RF signals 405 and receives RF signals 411 via antenna 406 from a small localized cell e g having a 100 foot radius to provide a wireless virtual link 12 to any cellular PCD 16a that comes within its cell as would occur for example when an ambulating patient wearing a cellular PCD 16a enters the cell Cellular PCDs 16a only one of which is shown in FIGS 1 and 3 each implement NSF 17 and include a cellular transceiver 410 that transmits RF signals 411 and receives signals 405 via antenna 412 Signals 411 include among other information the unique address 77 that identifies the PCD 16a The cellular transceiver 401 that receives signals 411 adds its network address 75 and forwards the signals to repeater 14 via cable 403 50 55 60 65 wireless CPU 400 and cable 20 Thus workstation 24 can identify the status and approximate location to an accuracy defined by the area of each cell of any cellu lar PCD 16a that is in active communication with a network transceiver 401 by identifying the network address 75 of the network transceiver 401 that is cur rently receiving signals 411 from that PCD 162 The network control embodied in the workstation supervisory software 24c and the network supervisory functions 17 implemented in repeater 14 and in each PCD 16 165 manages the information regarding the presence or absence of every device in use on
28. dentified and the locations at which the devices are used are determined based on the identities of the links that are in use The invention is advantageously employed to man age the use and operation of portable patient care de vices PCDs and track the locations of the PCDs as they are used at various bedsides and by ambulating patients Preferred embodiments include the following fea tures The devices send and receive messages to other de vices on the network via the links Each link is associ ated with a port of a multiport repeater or terminal server and the locations of the devices are determined based on the identities of the ports that are associated with links on which the messages appear The messages sent by a particular device identify that device e g by device type so that a device s location is correlated with its identity e g as a vital signs monitor an infu sion pump a ventilator etc Some of the links comprise unterminated cable such as coaxial or twisted pair wiring ends of which are disposed at different locations These links are consid ered unused unless and until they are terminated at which time they are designated as being in use Termination may be established in many different ways One simple technique is to manually connect a terminator to the cable at the time that the device is connected to the network But preferably the devices each include circuitry that when the device is con
29. des testing the impedance of the cable 50 The method of claim 48 wherein said determining further comprises responding to a determination that said end of said cable is already terminated by said another one of said devices at said location by placing an impe dance imbalance on said cable if the termination is improper for said one device said impedance im balance causing said another one of said devices to remove the termination and detecting the removal of the termination and causing said circuitry for terminating to terminate said cable 51 The method of claim 47 wherein said step of con necting includes connecting a terminator to said cable and to said device 52 A controller for managing multiple devices on a network that includes a plurality of links each one of said devices selectively operating in one of a normal condition and an alarm condition and being portable to allow the device to be operated in any selected one of a plurality of locations each of said links being assigned to a predetermined one of said locations and having a first state in which none of said devices is in electrical communication with said link and a second state in which at least of said devices is in electrical commu nication with said link said controller comprising means for identifying the links that are in electrical communication with said devices independently of whether said devices are in said normal condition or said alarm co
30. e de vices dedicated to e g ECG monitoring are perma nently mounted in each patient s cubicle The devices are connected via a private network ie a network having a communication protocol not available for general purpose use to special purpose displays located at the nurses station so that all of the devices can be Observed centrally The displays typically can only display limited information e g heart waveforms and heart rate and are thus unsuitable for general purpose use Moreover the patients generally cannot ambulate throughout the unit while connected to the monitoring devices 20 25 30 35 40 45 50 55 2 Ambulation is possible in stepdown units which gen erally monitor by RF medical telemetry exclusively patients electrocardiogram ECG ECG transmit ters worn by the patients transmit ECG data to antennas connected to a central nurses station for observation The telemetry antenna is permanently mounted near the patients rooms and hard wired to the nurses station SUMMARY OF THE INVENTION A general aspect of the invention is managing multi ple devices that are each suitable for use at a selected one of multiple locations using a network of links that are each assigned to one of the locations each link is selectable between a state in which a device is not using the link and a state in which one or more devices are using the link Links that are in use by the devices are i
31. e operation of the invention FIGS 4 6 are examples of numerous displays gener ated during the operation of the network FIGS 7A 7E show several of the icons used in the displays of FIGS 4 6 FIG 8 is an example of a working window used in the displays of FIGS 4 6 that enables the user to enter information FIG 9 shows an image of a front panel of a patient care device included in the displays of FIGS 4 6 FIG 10 illustrates terminating the network links ac cording to one embodiment of the invention and FIGS 11 and 12 show alternative termination techniques FIG 13 shows using the network with patient care devices that do not independently send messages over the network FIG 14 shows an alternative embodiment of the network FIG 15 shows patient care device connected to a twisted pair link of the network STRUCTURE AND OPERATION Referring to FIGS 1 and 2 bedside network 10 in cludes links 12 that originate from respective ports 13 of multiport repeater 14 and are wired to the vicinity of every bed Oe the bedside in every patient room 15 on a floor of a hospital Each floor in for example the general care areas of the hospital includes a bedside network 10 Network 10 may extend over more than one floor if the floor includes a small number of beds alternatively large floors may require more than one network 10 As described in detail below because general care patients normally are not using patien
32. ed to link 12 but not turned on Icon 102a in cludes a connector 120 within a blue colored square 122 Alternatively the display of icons for inactive bedsides can be suppressed to reduce the number of icons presented to the user When a PCD 16 is connected to the wall jack 60 assigned to the bed and turned on the network link 12 is terminated and the transceiver card 70 in the PCD has identified itself to workstation 24 icon 1024 is placed with icon 1025 FIG Icon 1026 also appears when a newly used cellular PCD 16a is detected by transceiver 401 Icon 1025 includes a yellow square 124 e g in place of blue square 122 and a question 126 appears inside of square 124 This cues the user that more information about this connection to network 10 is needed For example the identity of the patient in the bed may need to be entered if it has not already been supplied or confirmed In addition the user needs to ensure that the operational alarm limits of PCD 16 16a have been set For example assume that a PCD 16 has just been connected to network 10 at bedside 1101A labeled in FIG 4 The user clicks on the icon 1026 representing bed 1101A with pointer 108 and moves the pointer to workspace 104 This causes a virtual image 106 of the front panel of the PCD e g a vita signs monitor to appear Note that whenever a PCD virtual image 106 is displayed a path line 107 is displayed that connects nur
33. end disposed at one of said locations said end of said cable being unterminated when said link is in said first state said means for causing including means for connect 5 ing at least one of said devices to said end of said cable and terminating said cable to change said link to said second state and said means for identifying including circuitry for detecting that said end of said cable has been termi 10 nated as a basis for determining that said link is being used 39 The system of claim 38 wherein said means for connecting includes circuitry associated with said at least one device for determining if said link has already been changed to said second state by another one of said devices that was previously connected to said end of said cable at said location and that terminated said ca ble and circuitry for terminating said end of said cable unless said cable has already been changed to said second state 40 The system of claim 39 wherein said determining 55 circuitry includes circuitry for testing the impedance of the cable 41 The system of claim 40 wherein said determining circuitry further comprises circuitry responsive to a determination that said end 30 of said cable is already terminated by said another one of said devices at said location for placing an impedance imbalance on said cable if the termina tion is improper for said at least one device said impedance imbalance causing said another one of 35 said dev
34. evices receive input signals from an external source and determine whether said input signals are within a predetermined limit said status information indicating whether said signals are within said predeter mined limit 24 The system of claim 19 wherein at least some of said devices receive input signals from an external source and include a display for displaying data repre sentative of said input signals said processor including means for causing said dis play device to display an image that represents said device display 25 The system of claim 24 wherein at least some of said devices further include at least one control adapted to be manipulated by a user to control the operation of said device said processor causing said display device to include symbol in said image that represents said device control 26 The system of claim 25 wherein said processor includes at least one interface device that is operated by the user to emulate the manipulation of said device control 40 45 55 60 65 20 said processor sending commands to said device via said network that cause the operation of said de vice to be controlled 27 The system of claim 19 wherein said processor includes means for generating a plurality of formats for displaying said information about said connected de vices and responding to commands entered by a user to selectively display one of said formats 28 The system of claim 27 wherein at least
35. g that said end of said cable has been termi nated as a basis for determining that said link is being used 5 The system of claim 1 wherein at least one of said links communicates over a wireless transmission me dium with a said device disposed in a predetermined area said link including circuitry for designating a loca tion of said device within said area said means for iden tifying determining said location based at least in part on said designation 6 The system of claim 5 wherein said at least one link includes a plurality of transceivers each of which com municates with a device located in a regional cell within said area said means for identifying determining the location of said device based at least in part on the identity of the transceiver that is communicating with said device 7 The system of claim 6 wherein said devices each communicate by sending messages that identify said device and each transceiver includes circuitry for re laying messages received from a said device located in said transceiver s cell and for identifying itself to said means for identifying as part of said relaying 8 The system of claim 7 wherein said means for iden tifying includes means for determining the location within said area of a said device said based at least in part on the identification of said transceiver that relays messages from said device 9 system of claim 8 wherein said means for iden tifying includes circuitry ha
36. ice to remove the termination and circuitry for detecting the removal of the termination and causing said circuitry for terminating to termi nate said cable 42 The system of claim 38 wherein said means for 40 connecting includes a terminator that is manually con nected to said cable and to said device 43 The system of claim 1 wherein at least one of said links comprises coaxial cable 44 The system of claim 1 wherein at least one of said links comprises twisted pair cable 45 The system of claim 1 wherein said network is an Ethernet network 46 A method for managing multiple devices each of which selectively operates in one of a normal condition and an alarm condition each one of said devices being portable to allow the device to be operated in any se lected one of a plurality of locations comprising providing a network that includes a plurality of links each of which is assigned to a predetermined one of said locations each link having a first state in which none of said devices is in electrical commu nication with said link and a second state in which at least one of said devices is in electrical communi 60 cation with said link placing at least one of said devices in electrical com munication with a selected one of said links that was previously not in electrical communication with any of said devices and changing said selected 65 link from said first state to said second state inde pendently of whether said at le
37. ime The user selects which PCD front panel images to display by moving pointer 108 to the icon 102 of interest on map 101 holding down the mouse button moving pointer 108 to an empty window 151 158 and then releasing t he button This has the visual effect of drag ging the icon 102 to the window Pointer 108 is shown in window 153 Whenever pointer 108 is positioned in a window 151 158 that is occupied by an image path line 107 appears on map 101 In FIG 5 front panel images 160 of three vital signs monitors connected to network 10 at beds 1117A 11058 and 1101A are shown in windows 153 154 and 158 The front panel image 170 of a ventilator con nected to network 10 at bed 1112A is displayed in win dow 151 The front panel image 180 of an infusion pump connected to network 10 at bed 1119B is displayed in window 157 Each type of image 160 170 180 respec tively includes an outline 162 172 182 of the image buttons 164 174 184 used to control the PCDs and data 166 176 186 from the PCDs Workstation 24 5 10 15 20 25 30 35 45 14 determines which type of outline 162 172 182 to dis play by pairing the network address 72 that each PCD 16 16a transmits with data about the PCDs stored in database 36 or workstation memory 58 The arrange ment of images 160 170 180 including the labels of buttons 164 174 184 and the appearance of data 166 176 186 replicates those that are present on the ac
38. isplay a virtual image 106 of the front panel of a PCD 16 16a image 106 is of the front panel of a vital signs monitor manufactured by Protocol Systems Inc and is described in detail below The user chooses which PCD virtual image 106 to display by selecting the icon 102 that represents the location of the bedside PCD 16 16a of interest This is done by moving pointer 108 to the icon 102 with mouse 56 and clicking the mouse Workspace 104 has room for other windows not shown to enable the user to e g enter patient data set PCD operating parameters discussed below and perform other tasks without exiting the network application of workstation 24 header on display 100 includes buttons 110 112 that enable the user to quickly select the waveform display mode or the bedside display mode by clicking on the respective buttons using mouse 56 The user is also permitted to suspend the alarm tone generated by annunciators 30 but not the message displayed by the annunciators by clicking on the suspend alarm but ton 114 This technique can also be used to silence the local alarms produced by the PCDs When the alarm tone is disabled in this way the label of button 114 changes to resume alarm to indicate that action is required from the user to permit the alarm tone to again be generated After a time out period with no action from the user the alarm tone is reenabled and the label of button 114 changes back
39. n generate an overall view of the arrangement of PCDs connected to any patient for example one or more PCDs 16 connected to network 10 at any bedside on the floor by entering the bedside display mode 200 and clicking on the icon 102 that represents the location of interest As with 5 319 363 15 displays 100 and 150 bedside display 200 has header that includes icons to enable the user to switch to the waveform mode 110 to the map mode 1127 to silence alarm tones 114 The current message dis played by annunciators 30 is shown in area 109 A win dow 202 shows a small scale version of floor plan 101 and its colored icons 102 Path line 107 is drawn be tween nurses station 26 and the room in which the selected bed e g bed 1101A is located A window 204 to the right of floor plan window 202 contains a set of enlarged icons that identify the type of each PCD connected to network 10 and the status of each PCD below the bed number or an identification of the cell location and the patient s name For example the presence of vital signs icon 206 ventilator icon 208 and infusion pump icon 210 indicates that John Smith is connected to all three types of PCDs Each icon 206 208 210 is a square that includes a character that identi fies the PCD The color of the square indicates the status of the PCD e g green for satisfactory red for alarm and yellow for a suspended alarm or for a bed side for which informatio
40. n is needed The icon characters visibly indicate the operation of the PCD For example heart symbol 212 flashes with each wave detected by a vital signs monitor Fluid 214 empties from a concertina bellows 216 with each mechanical breath of a ventilator A symbol of an IV bottle 218 flashes to indicate the delivery rate of an infusion pump Display 200 contains seven other windows 221 227 for the display of virtual images 160 170 180 of up to seven PCDs that are in use by the patient and connected to the network For example the virtual images of the ventilator vital signs monitor and infusion pump being used by Mr Smith are displayed in windows 221 224 and 226 respectively The user interacts with virtual images 160 170 180 in the same manner as described above to monitor and control the operation of the PCDs Referring to FIGS 1 and 10 one way of providing the terminations 18 for each network link 12 that is available in a room 15 is to include circuitry 230 in each PCD 16 that internally terminates link 12 Terminating circuitry 230 includes a link tester 232 for determining whether link 12 is already terminated e g by another PCD 16 already connected to wall jack terminal 60 This is done for example by testing the characteristics of link 12 by time domain reflectometry TDR tech niques or simply by testing the DC resistance of link 12 such as between the center conductor and shield if link 12 is a
41. ndition by detecting the links that are in said second state independently of identities of the devices that are in electrical communication with said links and means for determining the locations at which devices are in electrical communication with said links based on said identifying
42. ned to unused links and refrains from retransmitting signals to unused links 15 The system of claim 13 wherein said unit is a multiport repeater 16 The system of claim 13 wherein said unit is a terminal server 17 The system of claim 1 wherein said means for identifying includes a processor for communicating with said devices via said links 18 The system of claim 17 wherein said processor is disposed remotely from at least some of said locations and connected to one of said links 19 The system of claim 18 wherein said processor includes means for receiving messages sent by said devices on said links and display device for displaying to a user information amp bout said devices based on said data 20 The system of claim 19 wherein said displayed information includes location information that identifies only those locations at which devices are in use on the network 21 The system of claim 20 wherein each one of said devices communicates information about the status of said device to said processor via its link said displayed 15 20 25 35 information including status information that indicates said status 22 The system of claim 21 wherein said displayed information comprises a plurality of symbols each of which has an appearance on said display that is selected to indicate said location information and said status information to the user 23 The system of claim 21 wherein at least some of said d
43. network 10 the data path i e hard wired link 12 or virtual link 12 being used by each device and the operational characteristics of each such device The basic function of multiport repeater 14 is to repackage messages re ceived at an active port address 131 13 2 and glob ally resend them from every other active port address 131 13 2 for receipt by a device a PCD 16 16a or workstation 24 linked thereto by the network In 5 319 363 9 addition the unique address 131 13 1 2 of each port identifies the origination of packets transmitted on its link 12 Each message is arranged as packet that includes the source address of the message e g the unique net Work address 72 of a PCD 16 or the unique address 77 of a PCD 162 the destination address of the message e g the network address of workstation 24 and data In addition repeater 14 inserts into the packet a specific identification stamp that identifies the address of the port 13 which received the packet from link 12 Other devices such as other PCDs 16 16 that receive the message after it is retransmitted by repeater 14 simply ignore it unless their network addresses match the mes sage s destination address Thus messages sent by a PCD 16 16a to workstation 24 are accepted by work station 24 and ignored by the other PCDs on the net work and messages sent by workstation 24 to a given PCD 16 16a are accepted by that PCD only Database
44. nsitive areas of the hospital or at certain times of day e g night when audible annunciation is offensive other means of draw ing attention to the presence of an alarm condition may be used as well For example workstation 24 may be equipped e g with a modem or a transmitting antenna to activate a standard alphanumeric display equipped 5 319 363 13 pocket pager e g beeper device such as is available from Motorola which has a silent vibrate mode Thus a pager equipped health care provider can be notified silently of alarm conditions and of the na ture and location of the alarms even when out of visual range of halway annunciators e g in patient s room Some alarm conditions such as minor variations in vital signs are not sufficiently serious to warrant imme diate action either to treat the patient or reset the alarm limits so that they are no longer exceeded In addition a provider or patient may knowingly anticipate engag ing in activity e g replacing or adjusting patient sen sors or probes such as electrocardiogram electrodes pulse oximeter sensors or vigorous ambulation or chest physical therapy which by virtue of disturbing patient sensors would cause alarm conditions due to artifact In such cases alarms for that patient are suspended in advance thus minimizing unnecessary alarm conditions and signifying the transfer of responsibility for surveil lance of patient status and f
45. o be used in several rooms over the course of a few days It therefore is difficult for a health care provider to determine the locations of the PCDs and of the patients who are using them other than by physically looking in every room on the floor Moreover it is often helpful to a patient s recovery process to allow the patient to ambulate dur ing the period that he or she is connected to the PCD locating such a patient is usually done visually by searching the hallways General care patients that are using the PCDs are typically the most acute i e medically unstable pa tients on the floor i e the patients that bear the closest monitoring by the floor s staff of health care providers Concomitantly the presence of a PCD at a bedside serves as a flag to indicate that the patient should be monitored carefully But because the PCDs are located inside of the room they often cannot be seen from the nurses station and alarms generated by the PCDs for example warning that the patient s cardiac functions have fallen outside of preset limits may not be easily detected Consequently the patient sometimes is moved to another room that is closer to the nurses station to reduce the possibility that alarms may go undetected An alternative is to move the patient to a specialized advanced care unit such as an intensive care unit ICU or stepdown unit for the short time that vital signs monitoring is needed In the ICU special purpos
46. or surveillance of PCD s from the workstation to a human health care provider When this occurs the user can override alarm icon 102d and the alarm tone generated by annunciators 30 This is done by clicking on an alarm button 113 displayed in the virtual image 106 FIG 4 of the alarmed PCD which causes buttons not shown for the functions being mon itored by the PCD to be displayed and enables the user to select one or more alarms to be suspended by clicking on a suspend button also not shown An overridden or disabled alarm icon changes to icon 102e FIG 7E a yellow square 136 enclosing character 138 that signifies that the alarm has been overridden e g character 136 is an alarm bell with diagonal line running through it Referring to FIG 5 in the waveform display mode 150 workstation 24 displays a set of windows 151 158 that can contain the virtual images of the front panels of up to eight PCDs 16 connected on network 10 A ninth window 159 displays a smaller scale version of floor plan 101 including the colored icons 102 FIGS 4 and 7 A header includes buttons 110 and 112 that allow the user to quickly select the other modes of display using mouse 56 The current alarm annunciator message is displayed in area 109 and button 114 is available for suspending annunciated alarm tones in the same manner as described above Of course there may be many more than eight PCDs 16 16a connected to network 10 at any one t
47. per and lower limits for each parameter The limits are set by clicking on the parameter set button 147 adjacent to the bar This causes the corre sponding image of an button 148 to appear de pressed and the alarm limits to be automatically set around the current physiological condition of the pa tient The limits are changed by clicking on the knob 146 and sliding it to the left or right releasing the button on the mouse sets the limit corresponding to the posi tion of the knob 146 Additional alarm parameters may be set or modified as necessary in the same manner When all alarm limits have been set as desired the user returns to the active map display 100 by clicking on done button 149 When workstation 24 determines that the patient s identity has been entered the operational limits of PCD 16 16a have been set and that information from the PCD is being correctly received over the network and is within the limits set by the user it changes yellow icon 1025 to green icon 102c FIG 7C thereby indicat ing that all is well at the location of the PCD Icon 102c consists of a character 128 such as a smiling face within a green colored square 130 Occasionally the information reported by a PCD 16 16a to workstation 24 falls outside of the limits set by the user or the PCD reports the occurrence of a fault This can happen in many ways For example the heart rate detected by a vital signs monitor may become irreg ul
48. repeater port 13 is connected via cable 19 e g a 10 base 2 coaxial cable to RF wireless network CPU 400 CPU 400 also implements network supervi sory functions NSF 17 and drives a wireless subnet work 420 via cable 403 which provides a bus to which numerous wireless cellular network transceivers 401 are connected only two such transceivers 401a and 4015 are shown Cellular transceivers 401 each imple ment NSF 17 and are e g mounted at various locations in common areas of the floor such as hallways and waiting rooms The operation of wireless subnetwork 420 is discussed in detail below Suffice it here to say that subnetwork 420 provides virtual links 12 between repeater 14 and one or more cellular PCDs 16a in use by ambulating patients e g who are walking in the hall ways 15a FIG 2 of the floor At present workstation 24 does not include a net work transceiver Oe a media access unit or MAU so cable 20 is connected via a separate transceiver 21 to the AUI access unit interface port of workstation 24 Workstation 24 is a computer e g a Sun Microsystems SPARC with a multitasking operating system 24 such as Unix that allows central processing unit CPU 24b to implement network supervisory functions 17 to support bedside network 10 while also allowing work station 24 to be used to run other applications programs 24d to perform other tasks such as compiling and re porting acuity levels ordering laboratory
49. ses station 26 with the room in which the PCD 16 16a is located This feature enables the user to associate image 106 with a real location on the floor The user enters the necessary patient information by using mouse 56 FIG 2 to select the patient button 111 on image 106 This causes a window not shown to appear in front of image 106 with spaces for entry of the patient data such as name room number and admitting physi cian via keyboard 54 or with other devices such as magnetic card or bar code readers not shown When all of the information has been entered the user clicks on an icon in the window to redisplay image 106 Referring also to FIG 8 the entry of a PCD s opera tional limits such as its alarm limits is also menu driven The user clicks on the alarms button 113 FIG 4 on the image 106 of the PCD of interest caus ing workstation 24 to display an alarm manager window 140 in work area 104 Alarm manager 104 identifies the types of functions 142 being monitored by the PCD 10 25 30 35 40 45 55 60 65 12 such as heart rate HR noninvasive blood pressure NIBP temperature TEMP invasive blood pressures and 2 and pulse oximetry SA02 For each function 142 one or more parameters 143 are also listed next to the current reading 144 for each parame ter The image of a sliding bar 145 with a knob 146 is provided for each parameter that enables the user to set the up
50. t care devices links 12 each are normally unused i e inac tive Each link 12 becomes active only when a patient care device PCD 16 16 such as an vital signs moni tor shown in FIG 1 a ventilator or an infusion pump is put into use on the link 12 in one of the ways de scribed below Links 12 that are wired into rooms 15 are unterminated when not in use When a PCD 16 is used in a room 1 it is connected to a link 12 in such a way as to terminate 18 the link PCDs 16 are portable so that they can be brought directly to the bedsides of any patient in need of them 5 319 363 5 repeater 14 is Ethernet IEEE 802 3 repeater with uniquely addressable ports 13 such as MMAC IRM Intelligent Repeater Module from Ca bletron of Rochester N H The operation of repeater 14 is managed by a repeater CPU central processing unit 15 which implements network supervisory functions NSF 17 including for example simple network man agement protocol SNMP capabilities other suitable network management protocols may be used instead One port 13 of multiport repeater 14 is connected via a cable 20 to a workstation 24 Ge a data processing device located at a nurses station 26 on the floor Links 12 and cable 20 are 10 base 2 coaxial cable but any suitable type of interconnection medium may be used instead For example links 12 and cable 20 can be twisted pair 10 base T or fibre optic wiring FDDI Another
51. t contains termi nator 18 is inserted between the PCD end of cable 250 and the network input port of PCD 16 Of course in either of the techniques shown in FIGS 11 and 12 if the person installing the monitor neglects to make the addi tional connections necessary to terminate link 12 work station 24 will not recognize the connection of the PCD to network 10 and will not accept messages from the PCD Other transmission media may be used for links 12 For example each link 12 may be two pairs send and receive of twisted pair wires Termination is provided by the transceivers 70 in the PCDs 16 FIG 1 Re peater 14 and workstation 24 detect whether the links are terminated to determine the locations of the PCDs in the same manner as described above Annunciators 30 can alternatively be controlled by a dedicated computer connected to a port 13 of repeater 1M rather than by workstation 24 Annunciators 30 can also be connected to a workstation port via a serial i e daisychained configuration Referring to FIG 13 network 10 can also be used with patient care devices that do not themselves have capability of transmitting over network 10 These PCDs secondary PCDs 16 are connected for example to an RS232 port on a primary PCD 16 i e a PCD that includes a network transceiver 70 to form a secondary network 10 at the patient s bedside Examples of such secondary PCDs are stand alone pulse oximeters infu sion pumps and portable
52. tes for each device the category thereof e g whether it is vital signs monitor an infusion pump or a ventilator The system also includes a processor such as a work station located remotely from the locations of the de vices e g at a nurses station for communicating with the devices via the network links The processor dis plays to a user information about the devices based on data received from the devices over the network The display enables the user to visualize at a glance the locations of all devices that are in use on the network and the status of these devices Several display formats are available to allow the user to view for example a hospital floor at various levels of detail For example one format displays a floor map to the user icons on the map indicate the locations of the devices currently in use on the network The appear ance of each icon e g its color designates the status of the corresponding device such as whether it is func tioning normally or is in an alarm condition Another display format allows the user to visualize virtual images of the front panels of numerous e g up to eight devices This is an invaluable tool that permits the user to monitor the operation of the device from the workstation without having to travel to the physical location of the device In yet another format the area around a particular location e g a patient s bedside is displayed to enable the user to r
53. to suspend alarm The header also includes an area 109 that duplicates the current message being displayed by alarm annunciators 30 In the absence of an alarm annunciators 30 display the date and time as shown in FIG 4 when an alarm tone is suspended as described above the message dis played by the annunciators and duplicated in area 109 5 319 363 11 includes the bed number of the alarm and the message SYS SUSP to indicate that the alarm tone has been disabled Other means of suspending the alarm tone which do not require the health care provider to be at the work station may be used as well For example a set of physi cal keys or buttons may be arranged at numerous loca tions throughout the floor or the health care provider may carry an infrared emitter These devices are linked to the workstation so that when actuated they cause the alarm tone to be disabled Referring also to FIGS 7 the appearance of each icon 102 e g its color is a function of the pres ence or absence of a PCD at the bed that the icon repre sents and the status of the PCD e g whether the iden tity of the patient who is using the PCD has been con firmed whether the user has set the PCD s alarm limits and whether the PCD is operating within the limits or is in an alarm condition FIG 7A shows an icon 102a for an inactive bedside that is a bed at which a PCD is not connected to a network link 12 or alternatively connect
54. tual front panels of the PCDs i e images 160 170 180 are virtual images of the front panel Referring also to FIG 9 image 160 for the vital signs monitor PCD 16 located at bed 1101A is shown detail Image 160 includes a header that identifies the bed number and the patient name John Smith and a footer that includes patient button 111 and alarm button 115 and a done button 111a that when clicked on by the user causes image 160 to be erased from the display Workstation 24 interprets the data in the mes sages sent by vital signs monitor PCD 16 and displays it as one or more virtual images of waveforms 190a 190c and multiple numeric readings 192 in the same format as on the front panel of the PCD For example waveforms 190 190 represent respectively Mr Smith s ECG III wave arterial ART blood pressure wave and pulse oximetry SAO wave The footer of a virtual image may also include space not shown for short messages For example a message on the virtual image of a vital signs monitor may read rhythm atrial fib and the message for an infusion pump may say fluid dextrose 5 water Numeric readings 192 permit the user to rapidly de termine a complete set of patient vital signs For exam ple Mr Smith s heart rate is 110 his blood pressure as measured invasively i e via a transducer located in an arterial catheter is 122 58 and as measured by a blood pressure cuff is 123
55. ucing an alarm when a message received by said processor from at least one of said devices indicates that said input signals are not within said predetermined limits 33 The system of claim 32 wherein said alarm device includes a display for identifying the location of said at least one device 34 The system of claim 33 wherein said alarm device includes means for generating an audio signal during said alarm 35 The system of claim 34 wherein said processor includes an interface device responsive to a command entered by the user for causing said alarm device to terminate said audio signal during said alarm 36 The system of claim 35 wherein at least some of said locations are sites on the floor of a building said processor including a display device for displaying a map of said floor and producing at a positions on said map that represent said sites symbols that identify the sites at which devices are using said links said display device including means for indicating that said audio signal has been terminated by altering the appearance of the symbol that corresponds to said at least one device 37 The system of claim 36 wherein said display de vice displays a symbol that represents said audio alarm signal said interface device includes means for enabling the user to select said symbol to cause said alarm to be terminated 5 319 363 21 38 system of claim 1 wherein at least one of said links includes a cable having an
56. ular PCDs 16a on the floor and the status of the PCDs 16 16a being used e g whether the PCDs are in an alarm condition The user also interacts with PCDs 16 16a from the workstation e g to control their operation and to change alarm limits etc Referring to FIGS 4 6 the user may select several different such displays only three of which are shown in the figures In the display mode 100 shown in FIG 4 a floor plan 101 is displayed which shows each room 15 on the floor as well as the hallways 15a and other common areas on the floor Floor plan 101 also includes one or more icons 102 in each room and in the hallways and common areas to designate the bed or beds in the room indicate the beds that are equipped with PCDs 16 connected to network 10 and show the approximate locations of active cellular PCDs 16a The waveform display mode 150 shown in FIG 5 permits the user to visualize in real time up to eight virtual images of front panels of PCDs 16 16a being used on network 10 A third bedside display mode shown in FIG 6 shows the user a virtual image of a selected bedside and displays icons that identify one or more PCDs 16 connected to network 10 at the bedside and indicate the status of each PCD Up to seven virtual images of PCD front panels can also be displayed for that patient Referring to the map display mode 100 in detail display 100 also includes a workspace 104 that enables the user to d
57. uvinnao uv 3AISVANI NON SXHOML3N 1 450 3dIM A 00 GL XHOMLIN 3015038 i INaLLVd gt SS313HIM 9 1 INAILVd OL A i di 92 NOILVLS S ASHNN 2 d 8 el Eer 35109 A 3AISVANI i i Ke 40013 NO z 3015039 OL SXNI1031vNINH3INQ gt H31V3d3H WOd 3OMGQJUuVOINJUVd e A Walvadau IHOdlL TN un 21 7 eop Sheet 2 of 13 5 319 363 June 7 1994 U S Patent 914 993 aS 210 tOt WOOH OLNI AM LOO 3Snow M s AV Idi 182 NO LVLS JSYNN vv 390148 06 135013 LN3WdINOS SWOOY LN3I LVd 3 40 01 SH3AIS2NVHL 2 1 56213 1 MOVE YVINCOW 321 3Q 395038 H3HIO OL ena OL Sheet 3 of 13 5 319 363 June 7 1994 10 8 Patent 44271139841 7 V9 102 11 102 y 8 eoz AVMTIVH 102 017 HA 2 JJA SsS3Hddv
58. ving a plurality of ports each of which is associated with at least one of said links said plurality of transceivers communicating with at least one of said ports said circuitry identifying the ports that are associated with links on which said mes sages appear and determining the locations of said de vices based at least in part on the identification of said ports 10 The system of claim 8 wherein the messages sent by a said device identify said device said means for identifying associating the identity of said device with the location of said device 11 The system of claim 3 or 10 wherein said means for identifying includes means for tracking based on said messages the identity of each device connected to the network at each location 12 The system of claim 11 wherein said devices in clude a plurality of categories of devices and further comprising 5 319 363 19 a database for storing information that designates for each device the category thereof and said means for identifying including means for access ing said database to enable said means for identify ing to determine the category of each one of said devices 13 The system of claim 2 or 9 wherein said circuitry comprises a unit for retransmitting messages received from a link to which one of said ports is assigned to the links to which other ones of said ports are assigned 14 The system of claim 13 wherein said unit ignores signals received at ports assig
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