WO2019069317A1 - Système de diagnostic virtuel continu et procédé associé - Google Patents

Système de diagnostic virtuel continu et procédé associé Download PDF

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Publication number
WO2019069317A1
WO2019069317A1 PCT/IN2018/050128 IN2018050128W WO2019069317A1 WO 2019069317 A1 WO2019069317 A1 WO 2019069317A1 IN 2018050128 W IN2018050128 W IN 2018050128W WO 2019069317 A1 WO2019069317 A1 WO 2019069317A1
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WIPO (PCT)
Prior art keywords
diagnostic system
patient
data
authorized
pathologist
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PCT/IN2018/050128
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English (en)
Inventor
Pranav Tripathi
Vimarsh Raina
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Doctore Health Services Private Ltd
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Doctore Health Services Private Ltd
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Publication of WO2019069317A1 publication Critical patent/WO2019069317A1/fr
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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/40—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for data related to laboratory analysis, e.g. patient specimen analysis
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H15/00—ICT specially adapted for medical reports, e.g. generation or transmission thereof
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H80/00—ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring

Definitions

  • the present invention relates to a seamless virtual diagnostic system and method thereof. More particularly, present invention provides an augmented, modular, flexible, highly scalable and efficient system in healthcare diagnostics where diagnostic experts like pathologists from remote sites are virtually capable of controlling multiple diagnostic analyzers on a real-time basis to conduct and validate the test and the patients are able to view the status of their diagnostic tests and view reports on real-time basis.
  • the system and method of present invention facilitates patients and pathologists in terms of time, cost, efficiency and clinical accuracy
  • the doctors or physicians require the services of pathologists for diagnosis of diseases from blood and body fluid samples of a patient to arrive at correct course of treatment. Many a times the purpose of the physicians to render services of more than one pathologist could be to obtain secondary opinion in certain circumstances take optimal decisions on the course of the treatment.
  • the sample/ specimen is taken at the hospital and is delivered to pathologist's laboratory for examination.
  • the hospitals have pathology laboratory within its premises reducing the need for the patient to travel to a third party laboratory hence reducing the turnaround time of the diagnostic reports.
  • the diagnostic reports are provided either physically or through electronic means.
  • Patent application no. CN102253922A published on 23 Nov 2011 discloses a method for remotely analyzing a pathological section where person who participates in analysis performs information communication according to a remote network platform.
  • the remote network platform comprises a central management server system, a pathological expert-side microcomputer device, a microscope holding-side microcomputer device and a visit-side microcomputer device in a wide area network environment and realize network connection, so broadcast surface transmission can be realized, realtime medical images are transmitted, an automatic microscope platform can be controlled remotely, and interactive voice communication is realized on the basis of sharing the real-time medical images.
  • Patent application no. CN102368283 discloses a digital slice-based digital remote pathological diagnosis system and a digital slice-based digital remote pathological diagnosis method.
  • the system comprises a remote consultation platform, a plurality of hospital ends and a plurality of specialist ends, wherein each hospital end comprises a fully automatic microscope system and a computer processing system; the fully automatic microscope system is controlled through the computer processing system; a pathological slice is automatically scanned and processed into a digital slice and is stored in a local machine or transmitted to the remote consultation platform or the specialist end through a network, and then a notice is transmitted to the specialist; and the specialist reads and analyzes the digital slice from an appointed storage position according to the notice and transmits a consultation opinion to the hospital end.
  • the specialist can diagnose the digital slice through a fixed or mobile terminal at any time and any place and transmits a diagnosis result back to the hospital end.
  • the system and the method are extremely suitable to be used under conditions of vast territory and higher shortage of specialist resources at remote rural areas like China; and through the system and the method, patients of countries can be quickly, accurately and effectively pathologically diagnosed and treated.
  • the CN102253922A and CN102368283 provides digital microscopy, however, does not teach the patients' access to real-time diagnostic status and reports electronically. It is limited to interaction between lab technician and pathologist.
  • the system includes a robotically controlled microscope at the remote site equipped with a video camera means for collecting video signals from the microscope.
  • the system also uses a bidirectional communication means to link the microscope with a pathologist workstation.
  • the workstation includes a monitor for viewing images received from the video camera means and control means for generating control signals which are sent over the bidirectional communication means to thereby remotely control the microscope.
  • the system also includes means for electronically storing the X, Y, and Z microscope stage coordinates for particular points of the specimen viewed by the pathologist together with means for storing electronically and reproducing photographically the images viewed.
  • the US 5216596 requires workstation set up at the pathologists end and the technicians end making the system complicated and cumbersome.
  • the present invention provides a system and method of seamless process work flow with focus of individual users such as front desk/technician/pathologist/ phlebotomist, their task lists and an end-to-end closure of loops of processes handled by them.
  • the system of the present invention is faster, cheaper, foolproof, clinically superior and specifically useful in medical emergency situations.
  • the main object of present invention is to provide a seamless virtual diagnostic system of testing and validation of patient samples in short turn around time
  • Another object of present invention is to provide a seamless virtual diagnostic system where the pathologists virtually are capable of controlling diagnostic analyzers on real-time basis to view, analyse, conduct, co-relate, report and validate the test results.
  • Yet another object of present invention is to provide a seamless virtual diagnostic system where the patients are capable of viewing the status of diagnostic tests and reports on real-time basis.
  • Yet another object of present invention is to provide a seamless virtual diagnostic system where the patients are capable of accessing the diagnostic tests and reports on their electronic device.
  • Yet another object of present invention is to provide a virtual diagnostic system enabling individual authorized users such as front desk/technician/pathologist/ phlebotomist to access their task lists and an end-to-end closure of loops of processes handled by them.
  • Yet another object of present invention is to provide a virtual diagnostic system which is faster, cheaper, foolproof, clinically accurate and specifically useful in medical emergency situations.
  • Yet another object of present invention is to provide an augmented, modular, flexible, highly scalable and efficient system in healthcare diagnostics.
  • Yet another object of present invention is to provide a seamless virtual diagnostic system to facilitate patients and pathologists in terms of time, cost, efficiency and clinical accuracy.
  • Yet another object of present invention is to provide a method of virtual diagnostic system with focus of seamless process work flow for an end-to- end closure of loops of processes handled by users on real-time basis.
  • Yet another object of present invention is to provide a method of virtual diagnostic system enabling the pathologists at remote sites to control various diagnostic analyzers including microscopes on real-time basis to conduct and validate the test.
  • Yet another object of present invention is to provide a method of virtual diagnostic system enabling transmittal of multiple data points - Textual, Numerical, Graphical, Image (still and live) from various diagnostic analyzers to a pathologist or multiple pathologists at remote locations for verification, co-relation, interpretation, reporting and validation of test results, and enabling the pathologist to access, view and control the analyzers including microscopes remotely.
  • the present invention provides a seamless virtual diagnostic system and method thereof.
  • the system of the present invention comprises of Central Information System (CIS), equipment interfacing platform and network architecture enabling seamless economic and efficient virtual diagnostic method in the field of healthcare technology.
  • the network architecture comprises of remote network server platform and an on-site network server platform.
  • the system of the present invention is faster, cheaper, foolproof, , modular, flexible, highly scalable, clinically accurate and specifically useful in medical emergency situations.
  • the system facilitates patients and pathologists in terms of time, cost, clinical accuracy and efficiency.
  • Virtual diagnostic system of present provides a seamless work flow by enabling individual users such as front desk/technician/pathologist/ phlebotomist to access their task lists and an end-to-end closure of loops of processes handled by them.
  • the system allows the pathologists at remote sites to control analyzers on real-time basis to conduct and validate the tests.
  • the system enables transmittal of multiple data points - Textual, Numerical, Graphical, Image (still and live) from various diagnostic analyzers to a pathologist or multiple pathologists at remote locations for verification, co- relation, interpretation, reporting and validation of test results, and enabling the pathologist to control multiple diagnostic analyzers including a microscope remotely.
  • the system also allows the patients to view the status of diagnostic tests, quality parameters and validated test reports on real-time basis and to access the diagnostic tests and reports on their electronic device.
  • the method of virtual diagnostic system focuses on providing a seamless process work flow for an end-to-end closure of loops of processes handled by users on real-time basis.
  • the CIS is a combination of real-time data points, scorecards, reports and visual analysis tools that capture, consolidate and display the current status of critical metrics for the healthcare facilities at single platform. It covers all the major processes for all the departments that are enormous helpful for core management in strategic, analytical and operational decision making.
  • the CIS is a foolproof and secure system accessible through unique identification code.
  • the user of the CIS includes authorized user of the system such as front desk, phlebotomist, technician, pathologist. It is not accessible to patients.
  • the equipment interfacing platform provides the access to the equipment including various diagnostic analyzers including microscope to the technician and the pathologist.
  • the equipment analyses the test result and generates four types of data: Textual Data, Numerical data, Graphical data and Images (still or live) (depending on the requested test).
  • Textual data Numerical data and Graphical - the data are temporarily stored on the on-site network server platform to wait for further action.
  • an electronic/ digital microscope automatically focuses on the slide and gives a command to the authorized pathologist user to virtually view and control the movement and find the area of interest.
  • the raw data obtained from equipment interfacing platform are stored in a raw format on the on-site network server platform and transmitted to CIS for conversion into machine readable medium.
  • Remote network server platform is connected to equipment interfacing platform.
  • Equipment interfacing platform is connected to CIS where raw data on equipment interfacing platform are converted into machine readable medium.
  • CIS is accessible to authorized users while raw data available on equipment interfacing platform are accessible to selected authorized users such as pathologist and technician. Patients have access to their validated tests/reports on CIS limited to the data accessible to them through unique number or barcode or identification number to ensure secure and limited access.
  • the system and method of the present invention provides a high quality and clinically accuracy that is both economic and faster means of diagnosis in the healthcare system. There is significant reduction in turnaround time and services of multiple expert pathologists at various locations can be availed simultaneously routinely and in certain critical circumstances or where physician/ doctor needs second or multiple opinion of the diagnosis and line of treatment.
  • Fig. 1 depicts the system of of seamless virtual diagnostic system
  • Fig. 2 depicts the process work flow of seamless virtual diagnostic system
  • the present invention provides a seamless virtual diagnostic system and method thereof.
  • the system is built on robust, scalable database models and has been stress tested to perform flawlessly during anticipated full scale deployment. Accessibility and availability of clinical information has been given special emphasis to leverage technology for scaling delivery such that information is made automatically available "when it's needed, where it's needed and for whom it's needed", enabling seamless economic and efficient virtual diagnostic method in the field of healthcare technology.
  • the system and method of the present invention provides high quality, clinical accurate, economic and faster means of diagnosis in the healthcare system. There is significant reduction in turnaround time and services of multiple expert pathologists at various locations can be availed simultaneously routinely and in certain critical circumstances or where physician/ doctor needs second or multiple opinion of the diagnosis and line of treatment.
  • this invention is not limited to the particular materials described, as they may vary.
  • the terminology used herein is for the purpose of describing the particular embodiment only, and is not intended to limit the scope of the invention in any way.
  • equipment refers to any equipment for diagnostic purpose including various blood and body fluid analyzers.
  • the singular forms "a”, “an” and “the” include plural reference unless the context clearly dictates otherwise.
  • the system of the present invention comprises of at least one Central Information System (100), at least one equipment interfacing platform (200), at least one network architecture, at least one equipment (300), at least one authorized user (600) and at least one patient (400).
  • Said network architecture comprises of remote network server platform (501) and network server platform (502).
  • Said at least one Central Information System (CIS) (100) is a hardware implemented software which displays a combination of real-time data points, scorecards, reports and visual analysis tools that capture, consolidate and display the current status of critical metrics for the healthcare facilities at single platform.
  • the CIS (100) covers all the major processes for all the departments that are enormous helpful for core management in strategic, analytical and operational decision making.
  • the CIS (100) offers an array of important business insights and alerts to enable the management to proactively identify problems.
  • the CIS (100) facilitates the decision makers to have an active intervention in real-time and to practice 'management by exception' at the same time.
  • the CIS provides the power to drill through current information, get alerts and identify potential operational issues as they happen.
  • the CIS (100) is a foolproof and secure system where authorized users (600) require unique identification code to have access to it.
  • the authorized users (600) of the CIS (100) includes but not limited to one or more authorized personnel of the system at front office (El, E2, E3, En), one or more phlebotomist (Fl, F2, F3, ..., Fn), one or more technician (Tl, T2, T3, ..., Tn), one or more pathologist (PI, P2, P3, ..., Pn).
  • the CIS (100) is not accessible to patients.
  • the CIS (100) provides overall summary available on the system. However, to access information pertaining to each of the patient (400) one requires unique identification code, ensuring the security of data.
  • the CIS (100) provides the information related to billing and finances, overall summary of the patients, supply chain data summary including data tested all across the centers and reruns at all the centers, details of the test conducted.
  • Said at least one equipment interfacing platform (200) is a computer implemented software and is connected to one or more equipments (300, 301, 302, 303, 304, 305,... n).
  • the equipment interfacing platform (200) provides direct access of the equipments to said authorized users (600).
  • Said equipment facing platform (200) stores the raw data on the on-site network server platform (502) that are eventually transmitted to the CIS (100) to convert into machine readable data.
  • the diagnostic data/ reports on CIS are accessible to all authorized users (600) through unique identification number / code/ barcode.
  • the patient (400) is able to access the diagnostic data and/ or report through patient's unique registration details generated and assigned by the CIS (100).
  • the patient's access is limited to the data pertaining to said patient's unique identification number.
  • the patient (400) can download the application of the system on any electronic device on patient portal (401) wherein said electronic device comprises of input modules, output modules and microprocessor.
  • the patient (400) can have access to the CIS (100) through any browser and can see all the updates related to the data and/or report through patient's unique identification number.
  • the virtual diagnostic system of present invention further comprises of communication means, IC arrangements to convert raw data into transportable data, at least one camera sensor, at least one image sensor, at least one microscope, at least one microprocessor, input devices, output devices, communication means, audio/ video or audiovisual means, display unit, storage means and power source.
  • the authorized pathologist (PI, P2, P3, Pn) is able to access equipments through equipment interfacing platform (200) through any electronic means comprising of at least one control panel, at least one microprocessor, input devices, output devices, communication means, audio/ video or audiovisual means, display unit, storage means.
  • the system of the present invention enables pathologist (PI, P2, P3, ..., Pn) at remote location to carry out examination of the sample/specimen through electronic means to provide diagnostic report and opinion.
  • the authorized pathologist (PI, P2, P3, ..., Pn) at remote location is capable of controlling the equipments (300) including microscope by means of control panel, of adjusting and controlling the microscope, the relative position of a specimen to the objective lens, the magnification of the specimen, and the focus of the microscope.
  • the camera sensors and image sensors capture the stereoscopic images and display the images on the display screen of the electronic means of the pathologist.
  • the pathologist (PI, P2, P3, ..., Pn) at remote location is capable of visualizing the live specimen/ sample and also capable to control the stage, of the microscope, focus, magnification and illumination.
  • the pathologist is able to view the video of the sample/ specimen in three dimensional mode.
  • the system is operated in such a manner that it accommodates all types of patients such as IPD (Inpatients department), OPD (Out-patients Department) as well as emergency patients.
  • the system also enables home collection of sample.
  • the system of present invention comprises of software integrated with hardware wherein said system enables process flow including billing, sample collection, sample testing, generation of test result, virtual microscopy for image based testing, storage of data on the system, data validation and report generation.
  • the system rely on system generated data with minimum human interference, thereby minimizing the error rates by using various automated barcode printing, sample labeling and dispensing processes.
  • Artificial intelligence incorporated within the system analyzes patient's data as soon as it is validated and can inform patients, physicians and the authorized users (600) to take appropriate action.
  • the system stores the patient's clinical data forever.
  • the system is developed in such a way that if the patient (400) goes to another centre enabled with the system of the present invention, the patient portal (401) captures the test results and stores it against the patients registered ID.
  • the patient (400) can print their report at any time, transparently see their samples journey, the quality parameters of the equipments on which the patients sample was performed as well as share their report and EMR with their physicians.
  • the method of the present invention comprises the steps of (Fig. 2) :
  • the system of the present invention provides a method of virtual diagnostic system enabling transmittal of captured image or live feed of images of microscopic slides/ specimens to pathologist at remote locations for validation and enabling the pathologist to command and control microscope or analyzer remotely.
  • the authorized personnel of the system at front office (El, E2, E3, ..., En) registers the details of the patient (400) . i.e. Name, DOB, Address, Photo etc.
  • An SMS confirmation will be sent to the registered mobile number with contents such as username and password for the patient (400) to view his report through electronic device.
  • the patient is able to select the type of investigation desired or required to be conducted through the system and can also feed or upload the previous history data and/ or prescription received on the system.
  • the system generates the invoice and payment gateways to expedite the diagnostic process.
  • the system assigns an internal TAT (turnaround time) alarm that enable the subsequent authorized users (600) to perform their duties in time.
  • the front office is a busy intersection to interact with patients (400) and is often fast-paced.
  • the front office personnel (El, E2, E3, ..., En) comforts the patients by anticipating their anxieties, answering their queries in completeness, responding to emergencies with a personal touch.
  • the front office personnel's (El, E2, E3, ..., En) primary duty is to capture as much of data both- clinical and demographic as possible so that the pathologist at the other end can give an accurate diagnosis.
  • the phlebotomist (Fl, F2, F3, ..., Fn) verifies the patient's identification from the system and gives a command to print a barcode sticker.
  • the barcode sticker is pasted to the sample container and the phlebotomist (Fl, F2, F3, ..., Fn) proceeds to collect the sample from the patient. a. In case the sample is not collected within the pre-specified time, an alarm is generated and notification is sent to the management team and intended phlebotomist (Fl, F2, F3, Fn).
  • the system enables sample collection at the phlebotomy room, can be used on the move and can even be used at each ward level of the hospital.
  • the collected samples are sent to the laboratory area for testing where equipments (300, 301, 302, 303, 304, 305,... n) are installed or placed.
  • the samples are first acknowledged and loaded on the specific equipment (300, 301, 302, 303, 304, 305,... n) depending on the nature of the test.
  • Samples are acknowledged using a barcode scanning procedure to authenticate the sample id with the patient id.Machine intelligence basis the command generated from the front office instructs the equipment (300, 301, 302, 303, 304, 305,...n) to perform the test that the patient (400) has requested for.
  • the equipment (300, 301, 302, 303, 304, 305,... n) analyses the test result and generates various types of data depending on the requested test such as:
  • the data generated are stored in raw format on equipment interfacing platform (200).
  • the system on the basis of the search results and command can pull or push the data to any authorized user (600) of the system. Every authorized user (600) of the system has certain privileges that enable him to preview, review or edit the data that has been temporarily stored on the network server platform (502).
  • the intended data are sent to the authorized pathologist (PI, P2, P3, Pn) for review.
  • the pathologist who can be anywhere in the world would need to log into the system via any electronic device.
  • a push notification can be sent in case the test result is urgent or is approaching turn-around time.
  • the authorized pathologist (PI, P2, P3, ..., Pn) is able to receive a worklist by the system and view specific test results of the patients (400).
  • the worklist provides a view to the authorized pathologist (PI, P2, P3, Pn) of the number and type of tests that have been allocated to him.
  • EMR electronic medical record
  • the EMR may include prescription scan, demographic details, clinical history, remarks, machine information, quality parameters, contact details of authorized technician (Tl, T2, T3, Tn), textual, numerical and graphical data generated from the equipment (300) and an icon which will take him to the slide image or live view of the microscope.
  • the authorized pathologist (PI, P2, P3, Pn) gives a command to validate and/ or requests for re-testing of the sample.
  • the pathologist gets remote access to the scanned/ stored images or access to the digital microscope through remote network server platform (501).
  • Digital controls via control panel or touch screen guides the authorized pathologist (PI, P2, P3, ..., Pn) to view the whole slide.
  • the pathologist PI, P2, P3, ..., Pn
  • various icons will be available to the pathologist to capture the area to interest image, take a snapshot, write his remarks, count various cells required for reporting and to validate the diagnostic report.
  • the system consolidates various diagnostic test reports from multiple analyzers and stores the data on the remote network server platform (501).
  • the validated diagnostic test report is stored on the CIS (100) and intimation command are issued to intimation to the authorized personnel of the system at front office (El, E2, E3, ..., En) and the patient (400) through electronic means. In selected cases, depending upon the medical circumstances, intimation to the referring physician / doctor is also sent.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Epidemiology (AREA)
  • General Health & Medical Sciences (AREA)
  • Primary Health Care (AREA)
  • Public Health (AREA)
  • Biomedical Technology (AREA)
  • Pathology (AREA)
  • Medical Treatment And Welfare Office Work (AREA)

Abstract

La présente invention concerne un système de diagnostic virtuel continu et un procédé associé. La présente invention permet d'obtenir un système de diagnostic virtuel entièrement automatisé à intervention humaine minimale, ce qui permet de réduire au minimum les taux d'erreur, le système fonctionnant de manière à s'adapter à tous les types de patients tels que ceux des services d'hospitalisation (IPD), des services de consultations externes (OPD), des services d'urgence ainsi que les patients soignés à domicile. Le système comprend un système central d'informations, une plateforme d'interface d'équipement, une architecture de réseau, un équipement, un utilisateur autorisé et un patient. Le système permet à des pathologistes situés au niveau de sites distants de commander des équipements en temps réel afin de réaliser et de valider un examen, et aux patients de pouvoir consulter l'état de leurs examens de diagnostic ainsi que les rapports en temps réel. Le système et le procédé selon la présente invention bénéficient aux patients et aux pathologistes en termes de temps, de coût et d'efficacité. FIG. 1:
PCT/IN2018/050128 2017-10-03 2018-03-07 Système de diagnostic virtuel continu et procédé associé Ceased WO2019069317A1 (fr)

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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110201904A1 (en) * 2010-02-18 2011-08-18 Mary Rose Cusimano Reaston Electro diagnostic functional assessment unit (EFA-2)
US20120173267A1 (en) * 2010-12-31 2012-07-05 Julian Omidi Database System for Medical Back-Office

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110201904A1 (en) * 2010-02-18 2011-08-18 Mary Rose Cusimano Reaston Electro diagnostic functional assessment unit (EFA-2)
US20120173267A1 (en) * 2010-12-31 2012-07-05 Julian Omidi Database System for Medical Back-Office

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