JP7145367B2 - Document preparation system - Google Patents

Description

The present invention relates to a document creation system for creating a document group consisting of a plurality of document categories for each case, such as an electronic medical record.

There are many cases where it is necessary to create and manage a document group consisting of multiple document categories for each case, such as a patient's chart. In the medical field, etc., staff members of many occupations are required to create a wide variety of complicated records, such as patient observation records, examination and treatment plans, and post-implementation evaluations. It can be said that skillfully creating such documents is the most important issue for improving work efficiency.
Prior art documents relevant to this application include: US Pat.

Patent No. 6038376 Patent No. 6585458

In order to search for necessary information among a large number of documents depending on the situation, many staffs are required to work for a long time. Occurrence of omissions or oversights may even cause medical accidents. This is due to visually confirming where the necessary information is recorded. In addition, the task of transcribing information such as disease names and blood test data to documents of different document categories with different purposes also causes an increase in the amount of work.

The present invention has been made to solve such conventional problems, and its object is to attach tags (input item tags) to input items that constitute a document, and to use the same input item tag for the same content. to avoid confusion in tagging and to facilitate the discovery of necessary information. To make it easier to find the necessary information by specifying the document category where such information exists, and when creating a new document, the contents of the input item tag are compared to the recorded contents of the same input item tag of the existing document. Eliminate manual transcription work by automatically referencing, in some cases, write to update/add the recorded content of the same input item tag of the existing document To provide a document creation system which is efficient and free from oversight by setting a high-level input item tag that summarizes the input item tags to facilitate handling.

As a means for achieving the object, in the document creation system according to claim 1,
In a document creation system that creates a document group consisting of multiple document categories for each project,
(1) input item tag creation means for creating an input item tag specifying the content of the input item for each input item constituting the content of the document to be created;
(2) input item tag list management means for centrally recording and managing the list of input item tags created by the input item tag creating means;
(3) input item tagged document creation means for creating a document using the input item tags selected from the input item tag list management means;
(4) in the input item tag list management means, an input item tagged document reference list management means for managing a reference list to the input item tagged document for each input item tag;
(5) A template document management table is provided for each document category in which the tagged document is registered as a document category template .

According to a second aspect of the document creation system, in the first aspect of the document creation system, the information included in the input item tags is objectified, and input is enabled using the objectified input item tags . .

A document creation system according to claim 3, in the document creation system according to any one of claims 1 and 2 , is provided with a function of retrieving and copying the same input item tag from other documents in creating a tagged document. It is characterized by

In the document creation system according to claim 4, in the document creation system according to claim 3 , the contents of other articles recorded in chronological order at a specific point in time are copied to the corresponding input item tag in the created document. It is characterized by having a function to

In the document creation system according to claim 5, in the document creation system according to any one of claims 1 to 4 , in the creation of the tagged document, an existing tag having the same input item tag as the input item tag in the created document an input item tag writing means for searching for a document with an existing tag, and writing the latest content described in the newly created document to the input item tag of the found document with an existing tag in the corresponding input item tag in the document with the existing tag; It is characterized by having

According to a sixth aspect of the document creation system, in the document creation system of the fifth aspect, the input item tag writing means is provided with writing time and person appending means for appending the writing time and the writer to the written content. Characterized by

In the document creation system according to claim 7, in the document creation system according to any one of claims 1 to 6, a higher-level input item tag that combines a plurality of input item tags is set , and writing is performed in units of the higher-level input item tag. made it possible .

In the present application, an input item tag is created because an input item tag creation means is provided.
Since the input item tag list management means is provided, the list of input item tags is managed.
Since the tag-attached document creation means is provided, the document is created using the input item tags.

In the present application, since the tagged document reference list management means is provided, the tagged document reference list from the input item tag to the tagged document is managed.

In the present application, since template document management means is provided for each document category, a tagged document is registered and managed as a template for the document category.

The present application has a function of converting an input item tag into an object including attributes.

In the present application, since an input item tag reference means is provided, an existing tagged document having the same input item tag as the input item tag in the created document is searched, and the input item tag described in the input item tag of the found existing tagged document is retrieved. Copy the latest content to the corresponding input item tag in the created document.

In the present application, since the latest time point setting means is provided, the time is set retroactively to the past time point, and the latest contents at that time point are copied to the relevant input item tag in the created document.

In the present application, since an input item tag writing means is provided, an existing tagged document having the same input item tag as the input item tag in the created document is searched, and the newly created input item tag of the found existing tagged document is added. Write the latest content described in the document to the relevant input item tag in the existing tagged document.

In the present application, since the writing time and person appending means is provided, the writing time and the writer are appended to the writing contents.

In the present application, since the high-level input item tag setting means is provided, a high-level input item tag that is a collection of a plurality of input item tags is set so that reference and writing can be performed in units of high-level input item tags.

FIG. 4 is a diagram for explaining the relationship between a list of input item tags managed by input item tag management means and input item tags arranged in documents of different document categories; FIG. 4 is an explanatory diagram of tagged document reference list management means; FIG. 4 is an explanatory diagram of template document management means for each document category; FIG. 10 is an explanatory diagram of objectification of an input item tag; FIG. 10 is an explanatory diagram of input item tag reference means; FIG. 4 is an explanatory diagram of input item tag writing means; FIG. 10 is an explanatory diagram of upper input item tag setting means;

FIG. 1 is a diagram for explaining the relationship between the list of input item tags managed by the input item tag management means of the present invention and the input item tags arranged in each document (tagged document) of different document categories. is.
In the input item tag list management means, the input item tags created and registered by the user (input item tag creation means) are centrally managed by the input item tag ID#.
Necessary input item tags are arranged for each document category, and the corresponding article is input following ":" after the input item tag (tagged document creation means).
The “:” delimiter between the input item tag and the input article is basically arbitrary, but when document data is recorded, “input item tag: input article” becomes a standard format called JSON as it is. Therefore, it can be said that this is a desirable embodiment.
As a recording format inside the computer, an XML format such as <input item tag>input article</input item tag> may be used instead of JSON.

FIG. 2 is an explanatory diagram of the tagged document reference list management means.
In the input item tag management means, for each input item tag, a list of document categories in which the input item tag is arranged is recorded as a tagged document reference list.
In this figure, the first column of each document reference list is the primary tagged document category.
The second and subsequent columns are sub-tagged document categories, and the article content entered in the corresponding input item tag of the main tagged document category is referred to and copied by the input item tag referencing means described later.
Note that the main/slave tagged document category may be specified by other means.
In addition, if the relevant input item tag of the document category with main tag has not been entered, after entering the relevant input item tag of the document category with sub-tag, the input content is The writing means may write to the relevant input item tag of the main tagged document category.

FIG. 3 is an explanatory diagram of the template document management means for each document category.
If an input item tag to be arranged is created as a template for each document category, the input item tags previously arranged as a template are automatically arranged when creating the document category.
Although this figure exemplifies a doctor's article, it is also possible to create templates for nurse articles, rehabilitation articles, and the like.
In some cases, for example, it is useful to define a plurality of templates for gastrointestinal physicians, neurosurgeons, etc. as templates for the document category of "doctor's article" and use them appropriately.

FIG. 4 is an explanatory diagram of objectification of input item tags.
In rehabilitation ability evaluation such as "walking ability", evaluation is performed according to the evaluation standard called FIM and the result is entered with 1 to 7.
In the case of free text input, fluctuations in notation such as half-width / full-width, and character expressions such as "correction independence" occur, which greatly hinders later statistical analysis.
At the time of inputting the input item tag, a list as shown in FIG. 4 is displayed, and if a format for selecting an appropriate evaluation numerical value is used, accurate and unwavering description can be easily performed.
Such a list, options, ranges of numerical values to be entered, etc. can be incorporated into an input item tag made into an object.
Further, by making the input item tags into objects, in creating the template of the document category, the input item tags objectified from the input item tag management means can be easily dragged and dropped onto the template document. Can create template documents.
In addition, there is a problem that the simple "walking ability:" text often has the ":" deleted or changed to ";" by the person entering the record, but this problem can be solved by making it an object. is.
By turning input item tags into objects, accurate and unwavering descriptions can be easily made, but recording documents in the form of objects requires a large amount of recording capacity, including information on options as shown in the figure. becomes.
For this reason, when editing a document, input is performed using input item tags that have been turned into objects, and after editing, only plain text such as "input item tag: result" such as "walking ability: 3" is recorded. As a result, only a small amount of recording capacity is required.
When editing again, the input item tag list management means should be searched and the object of the input item tag should be restored.

FIG. 5 is an explanatory diagram of input item tag reference means.
Most of the contents of the ``nursing care opinion'' are transcriptions of articles such as ``doctor articles'', ``nurse articles'', and ``rehabilitation articles''.
In the past, transcription was done manually, but if you set input item tags for input/referencing in the document category with master/slave tags in the document template, you can create a new "caregiver opinion" at the same time. For each input item tag, the article of the input item tag in the document category with the main tag of the input item tag can be automatically referred to and transcribed.
By automating the transcription work, the labor for document creation can be greatly reduced. In addition to the input item tags pre-arranged in the document template, if there is an input item tag that needs to be referred to in document creation, the relevant input item tag can be dragged and dropped from the input item tag management means in the same way. It is possible to automatically refer to and transcribe the article of the input item tag in the document category with the main tag of the input item tag.
In some cases, it may be necessary to grasp the situation of a patient or the like at a certain point in the past. For example, when an insurance company asks questions about medical fees, it is necessary to answer monthly changes in movement ability from the time of the first visit.
"Doctor articles" and "nurse articles" are recorded in chronological order, but it is often difficult to grasp the cross-sectional situation at a certain point in time.
At this time, when referring to the necessary input item tags by the input item tag reference means of the present invention, if the latest time point setting means sets the time point and refers to it, it is possible to easily comprehend the cross-sectional situation at each time point. becomes possible.

FIG. 6A is an explanatory diagram of input item tag writing means.
Temperature and blood pressure are measured while the nurses visit the hospital rooms. , it is efficient to transfer and write to the corresponding input item tag of "nurse record".
At the time of this writing, the author of the "nurse record" and the author of the "nursing patrol memo" do not necessarily match, so as shown in FIG. It is useful to clarify who is responsible for the records.
In some cases, it is necessary to perform multiple measurements within one working hour, but as shown in the figure, it is sufficient to write together the date and time of creation and the creator for each measurement (writing time person additional means).

FIG. 7 is an explanatory diagram of the upper input item tag setting means.
In the figure, "liver function test:" registered in the input item tag list management means is taken as an example.
If subordinate input item tags such as "GOT:" and "GPT:" are included in the attribute object of "liver function test:", these can be combined with the upper input item tag "liver function test:". Drag and drop operations can be performed collectively.
As a result, the test data of the input item tag can be referred to at once from the "blood test result" document.

Although the embodiments have been described above, the specific configuration of the present invention is not limited to the above-described embodiments, and the present invention includes design changes and the like within a range that does not depart from the gist of the invention.
For example, we have explained medical care as an example, but if it is necessary to create and manage a group of documents consisting of multiple document categories for each case, staff of many occupations will be able to observe and record the situation of the case, and plan investigations and problem solving. The present invention also includes the creation of a wide variety of complicated recording documents, such as evaluation after implementation of a plan.

Claims (7)

In a document creation system that creates a document group consisting of multiple document categories for each project,
(1) input item tag creation means for creating an input item tag specifying the content of the input item for each input item constituting the content of the document to be created;
(2) input item tag list management means for centrally recording and managing the list of input item tags created by the input item tag creating means;
(3) input item tagged document creation means for creating a document using the input item tags selected from the input item tag list management means;
(4) in the input item tag list management means, an input item tagged document reference list management means for managing a reference list to the input item tagged document for each input item tag;
(5) A document creation system comprising a template document management table for each document category in which the tagged document is registered as a document category template . 2. A document creation system according to claim 1 , wherein information contained in an input item tag is made into an object, and input is made possible using the objectized input item tag . In creating a tagged document,
3. A document creation system according to claim 1, further comprising a function of retrieving and copying the same input item tag from another document . 4. The document creation system according to claim 3, further comprising a function of copying the contents of other articles recorded in chronological order at a specific point in time to corresponding input item tags in the created document . In creating the tagged document,
searching for an existing tagged document having the same input item tag as the input item tag in the created document, and adding the latest content described in the newly created document to the input item tag of the found existing tagged document; 5. The document creation system according to claim 1, further comprising an input item tag writing means for writing to the input item tag in the existing tagged document. In the input item tag writing means,
6. The document creation system according to claim 5, further comprising writing time and person appending means for appending the writing time and the writer to the writing contents. 7. A document creation system according to any one of claims 1 to 6, wherein a higher-level input item tag is set by grouping a plurality of input item tags , and writing is possible in units of the higher-level input item tag .

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