WO2008059546A1

WO2008059546A1 - Apparatus for clinical automation

Info

Publication number: WO2008059546A1
Application number: PCT/IT2007/000788
Authority: WO
Inventors: Rafael Dalenz Bove
Original assignee: Rafael Dalenz Bove
Priority date: 2006-11-13
Filing date: 2007-11-08
Publication date: 2008-05-22
Also published as: EP2097847A1; ITRM20060615A1

Abstract

A method for remote control and management of a bed-ridden patient using multimedia means for the detection and the communication of the patients conditions to the outside world performs all the identification, collection and archiving operations of the clinical parameters coming from the clinical instrumentation connected to the patient. It is provided processing in real time of parameters detected in real time and resulting from detection of voice commands, of movements of limbs and/or head through an image processing software, motor activity through an image processing software, reference to clinical data for elaboration of automatic diagnoses, detection and management of data concerning automatic drag administrators and dosers, detection of movement of the bed and motorised surfaces, using portable terminals, automatic connection to a supervision centre/service centre for interfacing with a medical structure, providing the elements for remote management of a medical/clinical examination.

Description

TITLE: Apparatus for clinical automation

TECHNICAL FIELD

The invention refers in general to the biomedical engineering and telemedicine field, more in particular it refers to a remote control system of bedridden patients and to the relative components it is made up of.

BACKGROUND ART

From careful research about hospital problems regarding intensive care management and the treatment of less independent patients and who more generally need continuous attention, it was found that it is expensive to provide a service that needs costly resources for each patient while personnel is constantly decreasing.

In the industrial sector, present technology resolves the management problems of large quantities of machinery and ultra-complex systems with sophisticated industrial automation techniques. Such techniques and concepts will be extended in this patent to create an automatic management system, remote control and multimedia telesurveillance of patients in intensive care or in any case immobilised in a suitably equipped bed.

The aims of this invention can be summarised as follows:

- To promptly noting the patient's request for attention, whether the patient makes a direct request or whether the onboard bed equipment receives data with abnormal values, or whether the request for attention was programmed by the treatment protocols assigned to the patient.

- Continually collecting the clinical data read by the onboard bed equipment and send it to the supervision centre to be processed by software and for automatic generation of a possible diagnosis, having indicative value for the doctor in charge.

- Management of specialised equipment for automatic drug dosing

- Management of motorised equipment such as beds and surfaces.

- Managing the multimedia telesurveillance system prepared for: recognising several types of patient movement that would generate alarms, requests for service or attention; video communication with the attending doctor or family members. All these operation must be possible without the patient's manual intervention. - Manage access to the functions previously authorised by the system on behalf of doctors and family members using video phones and portable terminals

- Manage the centralised supervision system that can: support the new functionalities, automatically generating the connection between the patient who generated a service request signal and the staff responsible for such request; reaching the staff and acquiring the necessary resources by automatically sending text messages, e-mails and video phone calls.

- Automatically support service requests, whether they refer to comfort, such as moving motorised equipment, or requests through telephone or multimedia connections with relatives and doctors.

- Process clinical data collected for generating purely indicative diagnoses for the doctors

- Process and collect clinical data for subsequent transmission to the management servers that process historical archives, files, invoices, etc.

- Give prompt information and programme selected operations.

- Managing palmtop computers for system access by doctors and family members.

These and other aims that will be clear during the description are obtained by a telemedicine and clinical automation system based on the principles shown in the attached claims.

DISCLOSURE OF INVENTION

In the present invention there is the application of automated techniques for patients in intensive care using clinical dose-distributors and automatic remote controlled drug administrators combined with the automated management of medical and paramedic personnel.

Furthermore multimedia systems of computer-patient interaction activated by the movement of limbs or the head or voice commands from the patient are employed together with multimedia patience telesurveillance systems with the application of image processing techniques to identify the patient's clinical status.

Computerised systems are employed for moving the patient's bed or surfaces by remote control, by manual or vocal patient gestures, together with remote clinical data collection systems for automatic diagnostics and automatic systems for drug administration and dosing. All interactions between system and patients take place by: elementary voice commands actions on a remote control or by pressing a specific push button the automatic video surveillance system recognising a body or limb movement. Visual control and reading access functions are foreseen for reading the clinic parameters by both the doctors and the family using ordinary video telephones. The operator can program the system so that the patient's emergency situations can automatically be communicated to family and relatives by automatically sending SMS text messages. The GSM and UMTS communications modules used by the system can transmit the data collected for the patient to the management centre and to authorised personnel. Among the innovative contents of this invention, we mention:

• The operational procedure regarding image processing and algorithms for recognising the patient's status of pain and the consequent generation of a request for service or comfort by the patient to the system using predefined movements such as raising an arm or pronouncing key words with guided programming from a menu visible on the monitor and a synthesised voice giving further guidance.

• Public telephone network access procedures by the patient using voice commands, limb movements or with the aid of the supervision centre.

• The operational procedures included in the software for elaborating diagnostics starting from the data collected for the supervision centre.

BRIEF DESCRIPTION OF DRAWINGS

Only for purposes of example and with no intention to limit the sphere of valence of the general principle of what has been found, described below are some of the preferred productions with reference to the enclosed figures in which:

1. Figure 1 is a schematic block diagram of the apparatus in this invention;

2. Figure 2 is a schematic indication of the hardware modules that make up the system. With particular reference to Fig. 1, the following elements stand out:

11) Optional surveillance stations, connected in network

12) GSM, UMTS, GPRS, satellite, radio, telephone modems

13) Management Services staff responsible for the service with e-mail, SMS, fax, voice synthesis 4) Surveillance system

5) Onboard bed system with multimedia equipment

6) Portable terminal for medical personnel

7) Automatic connection via SMS and voice synthesis to staff responsible The onboard bed hardware modules are marked as:

1) Module for connecting to the clinical instruments near the bed

2) Module for connecting to the drug dose distributors and automatic administration equipment

3) Module for connecting to the mechanical equipment available for moving the bed, the motorised surfaces for positioning the monitor and TV camera

4) Multimedia module that interfaces Hi-Fi, TV and DVD devices, loudspeakers and microphone, headsets, video cameras, fixed phones, mobile phones and video telephones.

5) Onboard bed computer

6) Module for radio, mobile phone, satellite or telephone connection to the surveillance centre.

BEST MODE FOR CARRYING OUT THE INVENTION

The functional part of the system is made up of a group of modules aimed at applying the concepts of automation, telesurveillance and remote control for the treatment of patients temporarily immobilised on equipped beds.

The system performs all operations for reading, collecting and archiving the clinical parameters coming from the clinical instruments connected to the patient.

The system uses multimedia dialogue with the patient, using procedures that will be described below.

The system connects to drug administrators so that they can function automatically without the intervention of operators, when there are no risks for the patient. When there are risks for the patient or the patient requires attention, the system automatically opens a multimedia connection with a remote operator. The operator evaluates the clinical state of the patient and can interact with the onboard bed equipment: medical instrumentation, automatic drug administrators, devices for moving the bed and any mechanical elements such as surfaces for monitor and TV camera positioners. The system can make multimedia interconnection with the patient's doctor or family. The system of this invention collects all historical information in real time and transmits it to a distant control centre where it is examined by a clinical diagnostics program that automatically evaluates the physical state of the patient to see whether or not it is necessary to request operator intervention.

The system of this invention uses an image processing software to recognise the state of agitation or anomaly of the patient and generates the programmed alarms. The system takes into account not only the clinical needs of the immobilised patient but gives additional comfort, thanks to the multimedia connection to relatives and clinical personnel, and for making amusement apparatus available to the patient. The entire interface with the patient is managed with a program based on image processing and the patient can give commands to the system either by moving limbs, with voice commands, by wireless mouse, or using a guided procedure displayed on the onboard bed monitor and commented by a synthesized voice over the onboard bed speakers. Commands sent this way allow telephone or multimedia connection by the patient with the outside world, moving the bed and any motorised surfaces, moving the monitor and management of multimedia instruments (radio, TV, etc.).

The software of the entire system is prepared to follow the patient not just in centralised structures where the proposed system remains valid, but above all follow the patient to his home where he will be in a special equipped bed and followed by computer. Below is a comparison, only exemplary, of several aspects of this invention and their application in present-day technology: a. At present, checks on patients are done with video-surveillance equipment, with a TV camera fixed on the bed and a control monitor for each TV camera available at the local supervision centre. Hence the staff responsible for TV camera video-surveillance must pay constant attention. On the other hand the invention provides for a multimedia TV- surveillance system with image processing and telephone transmission to the remote supervision centre where a warning sound requires the intervention of the operator only when the alarm is effective or probable and displays the images acquired on the monitor. Automatic connection with the doctor and family is also guaranteed. b. For cabled data transport from some of the medical types of instruments to the local supervision centre where there is a display for each instrument under control, this invention returns the local automatic reading of equipment data with continuous elaboration and registration, automatic alarm generation and generation of probable diagnosis with telephone transmission of data to the remote supervision centre. c. This invention introduces automatic drug administration and dosing with the aid of dedicated instruments, an operation that is impossible today without manual intervention. d. There is still no remote management of patients, whereas the invention foresees the doctor's remote multimedia connection with the patient hospitalised in external structures with the use of portable terminals. e. The invention resolves the problem of sector studies based on infrequent and reduced statistical data, providing the necessary conditions to be based on data collected continually and on a large number of instruments. f. This invention introduces multimedia systems of surveillance and comfort with access to the system by doctors and family, which is inexistent in present technology. g. The invention surpasses cable data transmission that prevents the dislocation of beds to external structures, introducing in their place data and image transmission via GSM and UMTS that allow the patient to be moved to external structures.

The system includes three sub-systems, which are:

The onboard bed system that contains remote control hardware and the multimedia system of video surveillance and video communication,

The central remote control and surveillance system, palmtop computers for the doctor and family who want to access the systems permitted by the system.

The onboard bed system is constituted by the apparatus for the acquisition of data coming from the clinical equipment prearranged for monitoring the clinical parameters concerning the patient, managing the administrators and the drug dosers, manage the servo motors of the available mechanical equipment and manage the multimedia system of remote surveillance, manage the patient's communications with the outside world using mobile telephony. At present patient monitoring systems are only displays on electronic screens or monitors of the data and images of patients in observation regardless of the type of data concentration, elaboration or management.

The unit concerned in this invention, when acquiring data and transferring it to a surveillance information system, permits computerised management of patient data, case histories, etc.

Recording the critical status of the patient or his requests for service and comfort is done with an image processing system. A TV camera that can also be used for other purposes is located above the patient and monitors the patient's movements, for recognising conventional movements requesting services and comfort, and movements showing critical states requiring assistance, or monitoring the presence of motor activity for prompt recognition of the patient's state of health.

The system is made up of a series of hardware modules, some essential, others optional.

The modules used are:

Connection module with the clinical instruments near the patient's bed, in order to read all the available clinical parameters (optional)

Connection module with the automatic drug administration and dosing equipment

(optional)

Connection module with the available mechanical equipment that consents movement of the bed, motorised surfaces for positioning the monitor and the TV camera (optional)

Multimedia module (optional) composed as follows:

• TV camera

• Monitor

• Telephone, mobile phone and video telephone

• Hi Fi system, TV, radio, DVD, etc.

• Remote control Onboard bed computer

Connection module for radio, mobile phone, via satellite or telephone to the surveillance centre. Module for connection with the clinical instruments near the patient's bed for reading all clinical parameters available is an optional module made up of a group of standard entries, such as:

• Analogue entries, type 4-20 mA

• Analogue entries 0 -5 V

• RS 232 serial channels

• RS 485 serial channels

• USB channels

• Bluetooth channels

• Wireless channels

• HPIB channels

• LAN channels

These entries are aimed at connecting with the various clinical equipment on the market. Nevertheless it is the standard interface between external apparatus and onboard bed processor. The module is composed of an electronic card containing an onboard microprocessor with RAM memory and FLASH memory with preinstalled firmware that contains the program for managing the hardware interface with the clinical instruments, the communications protocols to be used with these instruments and the communications protocol with the onboard bed computer. The functions and the firmware are programmable by remote computer so that they can be adapted, even in the future, to all possible cases. Programming is done by local access using a programming device on one of the channels of the module or by using the onboard bed computer.

The card obviously contains all the electronic circuits inherent to the entries and the feed circuits.

Module for connection to the automatic drug dosing and administration equipment is an optional model made up of a series of standard exits such as:

• Analogue exits, type 4-20 mA

• Analogue exits 0 -5 V

• RS 232 serial channels

• RS 485 serial channels

• USB channels • Bluetooth channels

• Wireless channels

• HPIB channels

• LAN channels

These entries are aimed at connecting with the various clinical drug dosing and administration equipment on the market; nevertheless it is the standard interface between external apparatus and onboard bed processor.

The module is made up of an electronic card containing an onboard microprocessor with

RAM memory and FLASH memory where a firmware is pre-installed containing the program for hardware management interfacing with the clinical instruments, the communication protocols to be used with these instruments and the protocol for communication with the onboard bed computer. The functions and the firmware can be remotely programmed by computer for future adaptation to all possible cases. Programming is done through local access with a programming device on one of the module channels or by using the onboard bed computer.

The card obviously contains all the electronic circuits inherent to the input/output channels and the feed circuits.

A module for connection with the mechanical equipment available for movement of the bed, the motorised surfaces for positioning the monitor and the TV camera (optional), includes a commutation feeder to supply energy to the mechanical organs operated by remote control, the power circuits for the motor commands and the interface with the onboard bed processor. There is a remote programmable microcontroller on the electronic circuit. Programming is done by local access using a programming device on one of the serial channels of the module or by using the onboard bed computer.

A Multimedia module that interfaces Hi-Fi, TV, DVD, loudspeakers and microphones, headsets, video cameras, fixed and mobile telephones and video telephones is provided too.

A characteristic of the module is that the multimedia components interface with USB channels, in Ethernet, with serial communication channels and with PCI interface or IDE interface to the onboard bed computer.

The module is made up of an electronic circuit that sorts and concentrates signals from the multimedia peripherals so they can organically interface the onboard bed computer. The processing unit is a computer on industrial PC base with a multimedia operating system with an extended interface capacity, with backup unit and uninterrupted power supply.

An added feature of the computer is an optional double circuit with devices capable of mechanically switching from one computer to the other if one of them has a breakdown. A module for radio, mobile phone, satellite and telephone connection to the surveillance centre is made up of a series of a set RS232 or RS485 serial channels, USB channels and Ethernet lines that connect the onboard bed computer to commercial modems for connection via radio, mobile phone, telephone or satellite with the surveillance centre and with other network devices.

A feature of the module is that the communication protocols used are both proprietary and standard. Data transmission is encrypted in order to protect the system from intrusions. The system of onboard bed software modules include:

Multimedia operating system

Image processing module for recognising states of patient agitation or anomaly

Image processing module for recognition and execution of commands given by the patient using just limb movement

Voice recognition module for recognition and execution of commands given by the patient with voice commands

Synthetic voice module to interact with the patient

Module for facilitated access to the onboard computer by the patient for recognition and execution of the commands given by the patient with the remote control

Module of diagnostics, remote control, telesurveillance and data collection of the clinical devices connected to the system

Module for activating the mechanical devices

Module for managing communication with the remote centre

Module for managing the telephone and video telephone functions

PDA terminal communications and interface module

The onboard bed computer operating system is of the Microsoft Windows multimedia type that, using a remote control, allows to keeps the interfaced multimedia devices under control. The remote control software for this invention runs in background under this operating system and carries out all the automation functions previously described. An image processing software is always active, executing an algorithm measuring the speed and duration of the patient's changes of position. The programmer of this service has a table available that sets the state of alarm. Some of them are listed below as examples:

Alarm for abrupt movements

Revival alarm (eyes opening)

Alarm for continuous movements lasting longer than 10 seconds

Alarm for fast extended movements (falls)

Furthermore an image processing module for recognition and execution of commands given by the patient using just limb movement is provided.

This image processing software is always active, creating an algorithm identifying the position of a limb or the direction the patient's head moves. Identifying a raised limb, left or right, identifying lateral movement of the head left to right (meaning no) or up and down movement of the head (meaning yes) and the head being still, with the aid of a synthesised voice from the computer, are the elements for starting a conversation on the onboard bed monitor between computer and patient so that the patient can request attention from the operators, make phone calls to relatives, use the multimedia amusement system, move their bed, etc.

The onboard bed computer manages a voice synthesis module to aid the patient in using the multimedia services offered.

A module for facilitated access to the onboard computer by the patient is employed in order to recognise and execute the commands given by the patient with the remote control. There is facilitated access software allowing the patient to use the onboard bed computer with the remote control keypad.

Module for diagnostics, remote control, telesurveillance and data collection of the clinical devices connected to the system, continually collects the data arriving from the clinical instruments connected to the system, elaborates them and transmits them to the control centre. If enabled, the software commands the drug dosing and administration instruments. The software performs continuous diagnosis of the functionality of the electronic parts that comprise the system and, lastly, activates the alarms when situations of anomaly or doubtful interpretation are recognised.

When the onboard computer either receives commands from the remote control or the onboard bed keypad, or receives sign commands from the patient, it activates bed movement following the movement parameters for the specific type of bed.

The onboard bed computer manages the communications protocol with the control centre, it uses the cryptographic algorithms for data transmission and manages network communications with other devices

The onboard computer manages all the telephone functions serving the patient. It manages a diary/address book for use by the patient and activates a telephone service starting from either the commands entered on the remote control or the gesture commands.

The onboard bed computer communicates with the palmtop computer being used for the patient's relatives and doctors. The computer gives access to the patient's clinical data requested by the palmtop computer and puts the patient in communication with the palmtop user.

The central control and video surveillance system is made up in its basic version by a PC.

When it expands, the system becomes a network of PCs and client/server stations with access to the Internet.

The PC has a series of modems for radio, GSM, GPRS, UMTS and telephone connection with the onboard bed modules throughout the territory.

The PC is equipped with one or more monitors and a video-telephone system.

Automation software periodically interrogates the onboard bed systems and responds to their requests for services, and collects the data they have processed.

The system allows performing the following functions:

Video page display of the state of each patient

Monitor scan of the images from the patients' TV cameras

Monitor display of the clinical instrumentation measurements

Collection and elaboration of data from the clinical instruments connected to the patient

Automatic diagnosis and collection of clinical states of alarm for each patient starting from the data collected Video telephone communication between patient and surveillance staff, between patient and medical staff, between patient and family

Programming targeted interventions and programming assistance and first aid for needy patients

Search by telephone and text messages for authorised staff to assist the patient and automatic communication to them about assistance needed

Text message communicating the significant clinical data to attending doctors and family members

Management of the patient's clinical alarm situations following the system's automatic detection or the patient's SOS

Video telephone support to the patient and activation of the mechanical organs of the bed or the drug administrators

Breakdown detection and processing a maintenance request for the whole system

Processing archives, reports and printouts

Connection with other management programs

There is provision for using palmtop computers with GSM, designed for attending doctors or family members who wish to access the functions allowed by the system.

These are commercial terminals with dedicated software enabling network connection with the clinical automation system. This software contains the communications protocols and passwords necessary for network connection with the system and allows displaying of all the parameters from the clinical instruments, consultation of archive data, conversing with the patient, bed movement and programming multimedia apparatus, we well as establishing therapies by programming drug administration.

The palmtop's critical functions are protected by password and checks and consents by the surveillance centre, others are reserved solely to attending doctors.

INDUSTRIAL APPLICABILITY

The main innovation introduced by the invention is undoubtedly the application of automated techniques for intensive patient care together with automated management of medical and paramedic staff, providing the patient with health service and comfort and radically changing the patient's state of isolation. One advantage introduced by the patent is that patients do not necessarily have to be concentrated inside one or more hospital structures; they can be somewhere near where they live, as long as they have a properly equipped bed, which also increases medical attention and patient comfort.

The end result is structuring a system that can give complete hospital medical assistance to patients in structures outside the hospital, increasing surveillance, rationalising the work of hospital medical personnel and increasing the patient's comfort and services. More comfort and better services are made available to the patient, and all this decreases management costs thanks to automation techniques that allow intervention by the health operator only when it becomes necessary. One further advantage of this invention is the possibility to support clinical intervention without the need for geographical movement of medical personnel, when the multimedia connection is more than sufficient to resolve the problem, otherwise making an early request for an on-site intervention by health operators. This type of management reduces the number of medical staff needed. Furthermore, the doctor can be reached at his home or else replaced by personnel on duty in the area nearest the patient.

An innovative aspect of the invention is the creation of an integral, efficient system for managing the entire hospitalisation of patients in an automatic, computerised way, with patients no longer just concentrated in centralised structures but dislocated in the area, near their homes, integrating professional services with specialist personnel who may be anywhere in the territory, and for requests for medical personnel intervention where the patient is located, making use of conventional interventions at medical health structures nearby the patient, which can intervene under video surveillance by the attending doctor assigned.

The new comfort and breaking of the traditional isolation the patient was subjected to is also new.

Claims

1. Method for remote control and management of a bed-ridden patient using multimedia means for the detection and the communication of the patients conditions to the outside world characterized by processing an integrated set of parameters detected in real time and resulting from: i- detection of voice commands; ii- detection of movements of limbs and/or head through an image processing software; iii- detection of motor activity through an image processing software; iv- reference to clinical data for elaboration of automatic diagnoses; v- detection and management of data concerning automatic drug administrators and dosers; vi- detection of movement of the bed and motorised surfaces, using portable terminals; vii- automatic connection to a supervision centre/service centre for interfacing with a medical structure, providing the elements for remote management of a medical/clinical examination.

2. Method for control and management of a bedridden patient according to claim 1 characterized by: a. performing all the identification, collection and archiving operations of the clinical parameters coming from the clinical instrumentation connected to the patient, b. multimedially dialoguing with the patient, c. connecting to the drug administrators so that they can function automatically without the intervention of operators when there are no risks for the patient, d. having the possibility for multimedia connection with the attending doctor or the patient's family, e. collecting in real time all the historical information and transmitting it to a remote control centre where it will be examined by a clinical diagnostics program that automatically evaluates the patient's physical state in order to decide whether operator intervention should be requested, f. using image processing software to recognise the state of agitation or anomaly of the patient and generating the programmed alarms, g. giving the patient availability of multimedia connection functions with relatives and clinical personnel as well as entertainment apparatus, h. managing the entire interface for the patient with a program based on image processing, since the patient is allowed to give commands to the system by simple limb movement or by voice commands, or with a wireless mouse or by a guided procedure displayed on the onboard bed monitor and narrated by a synthesised voice over the onboard bed speakers, the commands given this way providing for the patient telephone or multimedia connection with the outside world, enabling movement of the bed and any motorised surfaces, movement of the monitor and management of multimedia instruments, radio and TV.

3. Method for control and management of a bedridden patient according to claim 1 and 2 characterized in that, in case there are risks for the patient or the patient requires attention, a multimedia connection with an operator in a remote location is automatically opened, the operator evaluating the patient's clinical state and interacting with the onboard bed equipment, medical instruments, automatic drug administrators, devices for bed movement, mechanical organs, surfaces, monitor and TV camera positioners.

4. Method for control and management of a bedridden patient according to claim 1, 2 and 3 characterized in that the image processing module for recognition and execution of commands given by the patient using just limb movement is arranged so that an image processing software is always active, performing a procedure identifying the position of a limb or the movement direction of the patient's head, by identifying a raised limb, left or right, identifying lateral movement of the head left to right, meaning no, or up and down movement of the head, meaning yes, and the head being still, in order to start a conversation on the onboard bed monitor between computer and patient, by means of a synthesised voice from the computer, so that the patient can request attention from the operators, make phone calls to relatives, use the multimedia amusement system, move their bed, etc.

5. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized in comprising a group of modules based on automation, telesurveillance and remote control appliances for the care of patients temporarily immobilised on equipped beds.

6. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized by including three sub-systems: i. the onboard bed system that contains remote control hardware and the multimedia system for video surveillance and video communication; ii. the central remote control and surveillance system; iii. palmtop computers for the attending doctor or family members who want to access the functions allowed by the system.

7. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized by the onboard bed system, comprising i- means for detecting data from the clinical equipment prepared for monitoring the clinical parameters regarding the patient, managing the drug administrators and dosers, managing the servomotors of the available mechanical equipment and managing the multimedia telesurveillance system, managing the patient's communications with the outside world using mobile telephony, detection of the patient's critical states or requests for services and comforts being performed by means of an image processing system using a TV camera located above the patient and monitoring the patient's movements, recognising both conventional movements requesting services and comfort, as well as movements showing critical states requiring assistance, and also monitoring motor activity in order to promptly recognise the patient's state of health.

8. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized by the onboard bed system, comprising the following hardware modules: a) connection module with the clinical instruments around the patient's bed for detecting all the available clinical parameters, b) connection module with the automatic drug dosing and administering equipment, c) connection module with the available mechanical equipment for movement of the bed, the motorised surfaces for positioning the monitor and the TV camera, d) optional multimedia module made up of: i. TV camera ii. Monitor iii. Telephone, mobile phone and video telephone iv. Hi-Fi system, TV, radio, DVD, etc. v. Remote control e) onboard bed computer, f) connection module by radio, mobile phone, satellite or telephone to the surveillance centre.

9. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized in that, in the onboard bed apparatus, the module for connection to the clinical instruments around the patient's bed for detection of all clinical parameters available comprises a standard input - output set, type: i. 4-20 mA type analogue entries ii. 0 -5 V analogue entries iii. RS 232 serial channels iv. RD 485 serial channels v. USB channels vi. Bluetooth channels vii. Wireless channels viii. HPIB channels ix. LAN channels, these input outputs units being apt for connection with various types of clinical equipment found on the market, with standard interfaces between external equipment and onboard bed processor, said module for connection to the clinical instruments comprising an electronic card containing an onboard microprocessor with RAM memory and FLASH memory, with firmware installed, that contains the program for managing the hardware interface with the clinical instruments, the communication protocols to be used with these instruments and the communication protocol with the onboard bed computer, the functions and the firmware being remotely programmable by accessing locally one of the module channels with a programming device or through the onboard bed computer.

10. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized in that in the onboard bed apparatus the module for connection to the drug dosing and automatic administration equipment is an optional module made up of a standard input-output set, type: I. 4-20 niA type analogue I/O exits

II. 0 -5 V analogue I/O exits

III. RS 232 serial channels

IV. RD 485 serial channels V. USB channels

VI. Bluetooth channels

VII. Wireless channels VIII. HPIB channels

IX. LAN channels. said I/O units being provided for connection with various types of clinical drug dosing and administration equipment on the market, having standard interfaces between external equipment and onboard bed processor, said module for connection to the drug dosing and automatic administration equipment being provided with an electronic card containing an onboard microprocessor with RAM memory and FLASH memory, with firmware installed, that contains the program for managing the hardware interface with the clinical instruments, the communication protocols to be used with these instruments and the communication protocol with the onboard bed computer, the functions and the firmware being programmable remotely by accessing locally one of the module channels with a programming device or through the onboard bed computer.

11. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized in that in the onboard bed apparatus the module for connection to the mechanical equipment available for moving the bed, the motorised surfaces for positioning the monitor and the optional TV camera includes a commutation feeder to supply energy to the mechanical organs for remote control operation, to the power circuits for the motor commands and to the interface with the onboard bed processor, on the electronic circuit of said commutation feeder, being provided a microcontroller remotely or locally programmable, using a programming device on one of the serial channels of the module or by using the onboard bed computer.

12. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized in that in the onboard bed apparatus the multimedia module that interfaces Hi-Fi, TV, DVD devices, or even loudspeakers, microphones, headsets, video cameras, fixed or mobile phones or video telephones is provided by an interface for multimedia components through USB channels, in Ethernet, with serial communication channels and with PCI interface or IDE interface to the onboard bed computer, the module including an electronic circuit that concentrates signals from the multimedia peripherals so they can wholly interface the onboard bed computer.

13. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized in that in the onboard bed apparatus the onboard computer is an industrial PC base computer with a multimedia operating system with an extended interface capacity, comprising a backup unit and uninterrupted power supply, provided with an optional double circuit with devices capable of mechanically switching from one computer to the other if one of them has a breakdown.

14. Remote control and management system of the conditions of a bedridden patient according to each of the previous statements, characterized in that in the onboard bed apparatus the module for radio, mobile phone, satellite and telephone connection to the surveillance centre comprises a series of RS232 or RS485 serial channels, USB channels and Ethernet lines that connect the onboard bed computer to commercial modems for connection via radio, mobile phone, telephone or satellite with the surveillance centre and with other network devices, since the communication protocols used are both proprietary and standard and data transmission is encrypted in order to protect the system from intrusions.

15. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims characterized by the onboard bed system including a set of software means, comprising: i. multimedia operative system ii. image processing module for recognising states of patient agitation or anomaly iii. image processing module for recognition and execution of commands given by the patient using just limb movement iv. voice recognition module for recognition and execution of commands given by the patient with voice commands v. synthetic voice module to interact with the patient vi. module for facilitated access to the onboard computer by the patient for recognition and execution of the commands given by the patient with the remote control vii. module of diagnostics, remote control, telesurveillance and data collection of the clinical devices connected to the system viii. module for activating the mechanical devices ix. Module for managing communication with the remote centre x. module for managing the telephone and video telephone functions xi. PDA terminal communications and interface module

16. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that the onboard bed computer operative system is a well known usual operative system, multimedia type, that, using a remote control, keeps the interfaced multimedia devices under control, the remote control software running in background under this operative system and earring out all the automation functions.

17. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that in the onboard bed apparatus in the image processing module for recognising states of patient agitation or anomaly, an image processing software is always active, executing an algorithm measuring the speed and duration of the patient's changes of position, the programmer of this service being provided with a board available that establishes the state of alarm, according to: -alarm for abrupt movements,

-revival alarm, eyes opening,

-alarm for continuous movements lasting longer than 10 seconds,

-alarm for fast extended movements, falls.

18. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that in the onboard bed apparatus is included a voice synthesis module to interact with the patient onboard bed computer managing a voice synthesis module to aid the patient in using the multimedia services offered.

19. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that the module for facilitated access to the onboard computer by the patient in order to recognise and execute the commands given by the patient with the remote control has facilitated access software allowing the patient to use the onboard bed computer with the remote control keyboard. 20. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that the module for diagnostics, remote control, telesurveillance and data collection of the clinical devices connected to the system performs an automation software that continually connects the data arriving from the clinical instruments connected to the system, elaborates them and transmits them to the control centre, commands the drug dosing and administration instruments, and performs continuous diagnosis of the functionality of the electronic parts that comprise the system and, lastly, activates the alarms when situations of anomaly or doubtful interpretation are recognised.

21. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that the module for activating mechanical devices activates bed movement, following the movement parameters for the specific type of bed, when the onboard computer either receives commands from the remote control or the onboard bed keypad, or when it receives sign commands from the patient.

22. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that the module for managing communications with the remote centre allows the onboard bed computer to manage communications protocol with the control centre, using cryptographic algorithms for data transmission and manages network communications with other devices.

23. Sy stem for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that the module for managing telephone and video telephone functions, controls all the telephone functions serving the patient, managing a diary/address book for use by the patient and activating a telephone service starting from either the commands entered on the remote control or the gesture commands described above.

24. System for remote control and management of the conditions of a bedridden patient according to each of the preceding claims, characterized in that the interface module with a palmtop computers provides the onboard bed for communication with the palmtop computer, being used for the patient's relatives and doctors, the computer giving access to the patient's clinical data requested by the palmtop computer and putting the patient in communication with the palmtop user.

25. System for remote control and management of a bedridden patient's conditions according to each of the preceding claims, characterized by the central control and video surveillance system comprising a PC, expandable in a network of PCs and client/server stations with access to the Internet, the PC providing a set of modems for radio, GSM, GPRS, UMTS and fixed line telephone connection with the onboard bed modules and relative, one or more, monitors and video-telephone system.

26. System for remote control and management of a bedridden patient's conditions according to each of the preceding claims, characterized by the central control and video surveillance system comprising automation software means which periodically interrogate the onboard bed systems and respond to their requests for services, and collect the data they have processed, said means performing in real time: i. monitor scannering of the images from the patients' TV cameras, ii. monitor displaying of the clinical instrumentation measurements, iii. collection and elaboration of data from the clinical instruments connected to the patient, iv. video displaying of the state of each patient v. automatic diagnosis and collection of clinical states of alarm for each patient starting from the data collected, vi. video telephone communication between patient and surveillance staff, between patient and medical staff, between patient and family, vii. programming targeted interventions and programming assistance and first aid for needy patients, viii. search by telephone and text messages for authorised staff to assist the patient and automatic communication to them about assistance needed, ix. text message communicating the significant clinical data to attending doctors and family members, x. management of the patient's clinical alarm situations following the system's automatic detection or the patient's SOS xi. video telephone support to the patient and activation of the mechanical organs of the bed or the drug administrators, xii. breakdown detection and processing a maintenance request for the whole system, xiii. processing archives, reports and printouts, xiv. connection with other management programs.

11. System for remote control and management of bedridden patient's conditions according to the preceding claims, characterized by the fact that palmtop terminals for the attending doctor or family members are commercial terminals with dedicated software enabling network connection with the clinical automation system, this software comprising the communications protocols and passwords necessary for network connection with the system and displaying of all the parameters from the clinical instruments, consultation of archive data, conversing with the patient, bed movement and programming multimedia apparatus, as well as establishing therapies by programming drug administration, the palmtop's critical functions being protected by password and checks by the surveillance centre.