WO2001088825A2

WO2001088825A2 - Distributed system for patient monitoring and patient data communication using time stamping

Info

Publication number: WO2001088825A2
Application number: PCT/CA2001/000722
Authority: WO
Inventors: John R. Mumford
Original assignee: Excel Tech Ltd.
Priority date: 2000-05-18
Filing date: 2001-05-18
Publication date: 2001-11-22
Also published as: AU6195301A; JP2003533305A; WO2001088825A3; CA2374948A1

Abstract

A distributed system for acquiring, disseminating, and outputting audio, video, and medical data is provided. The system is one which works in the field of telemedicine. There is at least one patient monitoring site (12a, 12b, 12c, 12d, 12e, 12f, 12g, 12h, 12i, 12j, 12k, 12l, 12m 12n) which comprises a plurality of input devices (20a, 20b, 20c, 20d, 20e, 20f, 20g, 20h, 20i, 20j, 20k, 20l, 20m, 20n, 22a, 22b, 22c, 22d, 22e, 22f, 22g, 22h, 22i, 22j, 22k, 22l, 22m, 22n, 24a, 24b, 24c, 24d, 24e, 24f, 24g, 24h, 24i, 24j, 24k, 24l, 24m, 24n) by which selected audio, video and medical data are captured for a patient; and at least one time server (26) to provide a base time signal which is referenced by the plurality of input devices at each patient monitoring site, so as to provide a synchronized time stamp on all data captured by the plurality of input devices. Each patient monitoring site is associated with a respective time server. At least one medical monitoring site (14a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j, 14k, 14l, 14m, 14n) comprises at least one output device (15) at which audio, video and medical data can be selectively output for any selected patient monitoring site, in synchronization based on the time stamp found on the data. The plurality of input devices and the at least one output device are connected to a network (18), and through the network to one another. Thus, any selected medical monitoring site may contemporaneously receive, review and analyze synchronized audio, video and medical data from at least one selected patient monitoring site.

Description

DISTRIBUTED SYSTEM FOR PATIENT MONITORING

AND REVIEW OF PATIENT DATA USING TIME STAMPING AND NETWORK COMMUNICATION

FIELD OF THE INVENTION:

[0001] The present invention provides a distributed system for communicating audio, video and medical data between patient monitoring sites, network servers and medical monitoring sites.

BACKGROUND OF THE INVENTION:

[0002] This invention generally relates to the field of medical signal monitoring through a network. If the patient and doctor are located remotely with respect to each other, while connected to a network, then this circumstance is often referred to as telemedicine. If the doctor and the patient are located close to each other, perhaps within the same hospital building, then this is referred to as conventional medical monitoring. In either case, the information from the medical signal acquisition devices attached to the patient can be communicated to the medical monitoring site, and observed, reviewed, and analyzed by the doctor, by means of a network.

DESCRIPTION OF THE PRIOR ART:

[0003] PEIFER et / United States patent No. 5,987,519 issued November 16,

1999 teaches a packet-based telemedicine system which communicates video, audio, and medical data between a central monitoring station and a remotely located patient monitoring station. A single transport/network layer is used for encapsulating the data in packets at the sending end, and for de-encapsulating the data at the receiving end. The system works essentially in real time. [0004] BALLANTYNE et al. United States patent No. 5,867,821, issued February 2, 1999, teaches a method and apparatus for electronically accessing and distributing personal health care data and services in hospitals and homes. However, the system requires interface between a pen-based computer (personal data assistant). at each patient care station, each of which is interconnected through a master library to nursing stations and other resources.

SUMMARY OF THE INVENTION: [0005] In accordance with one aspect of the present invention, there is provided a distributed system for acquiring, disseminating, and outputting audio, video, and medical data. The system comprises at least one patient monitoring site comprising a plurality of input devices by which selected audio, video and medical data are captured for a patient. There is at least one time server to provide a base time signal which is referenced by the plurality of input devices at each patient monitoring site, so as to provide a synchronized time stamp on all data captured by the plurality of input devices. Thus, each patient monitoring site is associated with a respective time server. [0006] There is also at least one medical monitoring site comprising at least one output device at which audio, video and medical data can be selectively output for at least one selected patient monitoring site, in synchronization based on the time stamp. All of the data is communicated over a network, to which the plurality of input devices and the at least one output device are connected, so that a selected medical monitoring site may contemporaneously receive, review and analyze synchronized audio, video and medical data from at least one selected patient monitoring site.

[0007] In keeping with the present invention, at least one patient monitoring site is located in physical proximity to its associated time server to ensure accurate synchronization of the time stamp on all data captured by the plurality of input devices. [0008] Generally, the system is configured so that each patient monitoring site further comprises at least one output device by which selected audio, video and medical data are output.

[0009] Still further, the system of the present invention provides for a medical monitoring site to further comprise at least one input device by which selected audio, video and medical data may be input so as to provide bilateral communication between the medical monitoring site and the patient monitoring site. [0010] In a more generally configured distributed system for acquiring, disseminating, and outputting audio, video, and medical data, in keeping with the present invention, the system further comprises at least one intermediate server for selective storage of data captured by at least selected input devices from selected patient monitoring sites. This permits the review and analysis of the time stamped data at a time other than the actual instance when an event may occur. Thus, the at least one medical monitoring site may selectively output data for at least one selected patient monitoring site, in synchronization based on said time stamp, but at a later time than when the data is collected from the patient monitoring site. [0011] Accordingly, a selected medical monitoring site may receive, review and analyze stored synchronized audio, video and medical data from at least one selected patient monitoring site from said intermediate server, at any selected time. [0012] Still further, in a system in keeping with the present invention, there may be a plurality of intermediate servers, wherein each of the intermediate servers stores data from a selected specific input device at each patient monitoring site.

[0013] Alternatively, when there are a plurality of intermediate servers, each of the intermediate servers may be arranged so as to store data from a selected group of patient monitoring sites.

GENERAL DISCUSSION OF THE PRESENT INVENTION:

[0014] At present the full complement of medical devices required for continuous or periodic monitoring of complicated diseases like epilepsy are not available in one single unit configuration. In particular, medical signals from the brain, medical signals from the heart, medical signals associated with respiration, medical signals associated with pressures, medical signals associated with concentrations of chemicals, audio signals associated with the patient, and multiple video camera signals associated with the patient, are recorded independently of each other on separate electronic devices. It is desirable to link all of these signals together exactly in time so that each of the signals may be accurately correlated with the others. [0015] In particular, in intensive care unit monitoring, cardiac care monitoring, epilepsy monitoring, surgical monitoring, and sleep monitoring, among other forms of so called "long term patient monitoring", the accurate recombination of these signals on one computer display, crt, or led, etc., facilitates the medical practitioner with an improved ability to diagnose the medical conditions associated with a particular patient. The limitation of the current art is that the individual medical, audio and video devices required to create a total description of the state of the patient at any point in time are not adequately connected and correlated on to another, in time. In particular, accuracy drifts in the master oscillators in each of the devices results in large skews in the "time" of the devices. [0016] For example, a commercially available video camera generating continuous video data has been shown to drift by as much as plus or minus five seconds worth of frames over a twenty four hour period. Relying on the number of video frames that were recorded by the video camera is not accurate enough, without periodically resynchronizing the medical system. Resynchronizing the system has the disadvantage of dropping some of either the medical information, or the video or audio information, to realign the data streams.

[0017] One method of overcoming this obstacle is to com ect each of the medical, video and audio devices together through the same master computer so that the master computer can form data streams that consist of simultaneous recording of the medical, video or audio data to the server system. The disadvantage of this arrangement is that the processing ability of a single computer will ultimately be restricted by the processing power of the computer, or the network bandwidth between the computer and the network servers. In particular, if a playroom were constructed for the treatment of epilepsy patients, using a large number of medical devices, audio devices and video devices for the continuous simultaneous observation of those many patients across the many cameras, one computer cannot process all of the information. Also, it may be desirable to allow the patients - if they are children, in the epilepsy example being discussed ~ to play without the encumbrance of being tethered by electronic cables to the computer. Wireless headboxes that acquire the medical signals and broadcast those signals to a storage server are desirable. In the same way, patients in different scenarios are encouraged to be ambulatory as part of the procedure that they are undergoing. [0018] For example, a pregnant mother in labor may be encouraged to walk up and down the halls of the hospital, or a person recovering from a heart attack will engage in walking in the hospital or a designated exercise facility associated with the hospital, as part of the recovery process. Further, it may be desirable in an operating theatre for an expert physician, such as a neurologist or neurophysiologist, to monitor the patient from outside the operating theatre. This arrangement may be required for reasons of sterility, convenience, or the desire to make the expert physician's expertise available to more than one operating procedure at the same time. [0019] It may be desirable in many circumstances for there to be multiple medical data streams and multiple camera views which are not restricted, so as to form independent teleconferencing views with the surgeon, the surgeon's assistants, an anaesthesiologist, operating room nurses, technologists, or other medical personnel. Likewise, video views of the surgical field, either external or internal (laporascopic) views, or video data views generated by microscopes, surgical head mounted cameras, etc., may be required during any given procedure. Of particular interest is the process of quantifying the relationship between interaction with neurological structures of the patient, and electrophysiological changes that may occur in the patient. Another excellent example of the efficacy of the present invention showing the benefits thereof over the existing art, is in the area of long term sleep studies for the accurate diagnosis of sleep apnea, and the like. Here, multiple camera views can be such as from conventional video cameras, or the video views may be generated by specialized imaging equipment such as fluoroscopy equipment, or imaging ultrasound equipment. Thus, it is possible to have a conventional video view, a medical device physiological data view, and a video view from a specialized piece of medical imaging apparatus. In this way, adverse changes in the electrophysiology of the patient can be accurately correlated with actual anatomical configurations of the patient. For example, an occlusive blocking of the throat can be recorded by an ultrasound machine, while at the same time a wide angle view of the patient sleeping can record the sleep apnea. Moreover, the eeg data for the patient, his or her respiration, and cardiac medical signals, can provide simultaneous evidence of the changes. [0020] The present invention addresses the requirements of these scenarios and many others by providing for a common time signal distributed to all of the individual devices associated with the patient monitoring site. Each of the devices can then digitize not only the medical, video or audio signal, but it will also record the time information associated with the moment of digitization of every data sample ~ or at least some periodic number of digital samples — such time coding being embedded in the data streams often enough to guarantee the accurate reconstruction of the complete medical information at a medical monitoring site. The medical monitoring site may be located inside the patient monitoring area or remotely, and it may be connected by TCP/IP protocols to intermediate servers, to the network, and to other patient and/or medical monitoring sites.

[0021] For these examples, and many others where the medical system needs to maintain high accuracy synchronization over a long term among many video, audio and medical data sources, the technique of counting frame information or digitized sample count cannot be used to accurately synchronize the information at a patient monitoring site. The present invention allows for the writing of medical, audio or video data from independent devices with time synchronization information encoded in the data, such time synchronization information being provided to all of the devices that make up the total of the devices in the patient monitoring site by an independent time server which broadcasts time information to all of the devices in the patient monitoring system. Alternatively, one of the devices in the patient monitoring system may assume the role of master time server, and it will broadcast time information to all of the other devices in the medical system associated with that patient monitoring site. Such time information can be broadcast to all of the devices by suitable network means including but not restricted to a LAN (local area network), WAN (wide area network), internet, intranet, extranet, wireless area network, wireless LAN, cable TV network, asynchronous transfer mode network, public switched telephone network, integrated services digital network, infrared network, microwave relay network, satellite network, or any other type of network capable of transmitting packets formatted in TCP/IP protocol. [0022] The patient monitoring site can be comprised of a great many data acquisition devices including but not limited to video, audio and medical content devices such as ecg, respiration, eeg, blood pressure and rate, temperature, etc. Further, multiple data acquisition devices of the same type, for example but not restricted to, multiple video cameras, can be connected at the patient monitoring site. Each data acquisition device is in communication with each of the other devices at the patient monitoring site to maintain time synchronization between all the devices. Each data acquisition device can format its data in TCP/IP protocol, but that fact is not germane to the present invention. [0023] It is useful to not have to accumulate all of the audio, video and data streams into a single communication stream. For example, video and audio of the patient may be gathered and transferred to an intermediate server via a high speed network like a LAN or DSL, while the patient medical data may be transmitted to an intermediate server by a low speed wireless network such as CDPD, CDMA or infrared. This allows to the patient the important mobility required to perform their normal tasks without being tethered to a machine.

[0024] Because patient ambulation is a critical part of the recovery process, and mobility is desired in many hospital or remote homecare monitoring settings, the medical system does not require independent audio, video or medical devices to be hard wired together. The data, because it is time stamped, does not need to be aggregated into one control unit for communication to the intermediate servers via one network pathway. Independent data streams from each of the audio, video or medical devices can be communicated to one or several intermediate servers, which can be located anywhere on the internet, via TCP/IP over independent network pathways. The data stream from each independent audio, video or medical device contains time information allowing the data to be resynchronized at a later time at the medical monitoring site.

[0025] Resynchronizalion is critical, because medical physiology must be identically correlated with video movement in for example the field of epilepsy diagnosis. As one of many possible examples, small patient worn medical devices can transmit information to respective intermediate servers directly through wireless connection to the internet, while high bandwidth devices such as video cameras can simultaneously transmit information over higher bandwidth land lines to the same or different intermediate servers. A further advantage is that multiple synchronized audio, video and medical data feeds may be added to provide to remote medical practitioners more complete information about the current state of the patient. An example where this is important is in remote operating room monitoring, where multiple independent cameras can provide simultaneous views from, but not restricted to, a face view of the surgeon for teleconferencing, a wide angle view of the surgical field, a close up view of the surgical field through a microscope, and views from laporascopic cameras, all perfectly synchronized in time with the electrophysiological monitoring devices connected to the patient.

[0026] Another important example is when multiple high bandwidth video streams from different cameras are written independently to an intermediate storage server, while medical data streams are also being written independently across the same or different network path. The medical monitoring site can be configured to display the appropriate video stream that shows the most relevant view of the patient, having regard to the medical data being viewed. [0027] Because the patient monitoring site does not have to provide storage or display of the medical signals, the medical devices at the patient monitoring site can be made extremely simple. A patient monitoring site medical device can consist of a medical transducer, an analog to digital converter, and a small cpu to control the digitization and transmission of the data to the network. Software to store, process and display the data does not need to be located at the patient monitoring site or the medical monitoring site, but can be stored independently on intermediate servers that are connected to the network. This software can be uploaded from one or several of the intermediate servers at the time the particular data stream is chosen for review. This is advantageous for many reasons: software can be managed centrally so each individual medical monitoring site will always have the latest version of software without a difficult maintenance effort; further, the institution benefits because this software is available to all potential medical monitoring sites, including ordinary PC's. [0028] Another distinct advantage of the present invention is that the hardware for the processing and storage of many types of medical signals can be replaced by intermediate servers. Even more flexibility is achieved when individual medical devices are connected directly to the network, time synchronized with other devices on the network, and generate independent data streams. In fact the acknowledgement of the storage operation by linked software can trigger other events. Data may be analyzed, the results of that analysis directed to either the medical monitoring system, the patient monitoring system, or an administrative system for appropriate action. Further, the ability to encode time information with or into the medical data stream itself allows many independent medical devices to feed their data to independent files located on independent servers. The medical monitoring site can retrieve the data from many different locations and create a new medical montage. In a multi-modality setting, cardiac, eeg video, ultrasound, blood pressure data, among other feeds, can be displayed on the same screen, thereby providing the opportunity for the medical practitioner to determine causality between the changes in one medical signal with another. For many tasks such as recording a blood pressure, taking a temperature, among others, are in fact providing documentation for the respective patient. [0029] Because the intermediate servers are readily accessible from the patient monitoring sites, many tasks that previously were not digitized directly can be affordably integrated into the electronic medical record. A further advantage of the present invention is that the common infrastructure may be leveraged across many medical, audio or video acquisition devices, allowing additional devices to be added to the patient monitoring site at a fraction of the cost of conventional dedicated medical instruments. Another advantage of the present invention is the ability to develop time synchronized views of many modalities that are usually recorded in completely independent locations, and which are generally not well correlated with one another. An excellent example is when the volume and time of delivery of a drug by a networked drug delivery device forming part of the patient monitoring system is synchronized with an electrophysiological recording of the physiological parameters that the administered drug is meant to influence. Correlations between changes may be more easily observed. [0030] Any medical monitoring site can connect through TCP/IP network protocols to one or several intermediate servers, and can request one or multiple data streams from files generated by devices located at the patient monitoring site. The high speed of networks and intermediate servers results in only a slightly delayed view of the patient monitoring site information.

[0031] A further distinct advantage of the system is that multiple caregivers can comiect to the same patient at the same time, by simultaneously connecting to the intermediate servers. In this way, independent doctors and telehealth nurses may perform a simultaneous medical consultation without overloading the communication capacity of any of the audio, video or medical devices located at the patient monitoring site. A further advantage of the system is that the data is automatically archived to an intermediate server or servers in real time.

[0032] In some circumstances, multiple medical students may be observing a patient for instructional purposes, for example. Then, it is desirable to connect directly to the patient without excessively burdening the server. In this circumstance, it is desirable to utilize simultaneous broadcast protocols like UDP, (universal datagram protocol), so that broadcast communication about an individual patient monitoring site can occur to many medical monitoring sites. [0033] It is extremely important that all of the medical, audio and medical data feeds be time synchronized for review, so as to be able to accurately analyze the cause and effect relationships between the data streams. In particular, if the data streams take different paths through the network to different intermediate servers, the time information must be properly encoded in the data stream at the source before the transmission to the network or accurate re-assembly of the information will not be possible.

[0034] Thus, the present invention provides a medical system for transmitting time coded audio, time coded video, and time coded medical data between patient monitoring sites and medical monitoring sites by means of network communication, and usually through one or several intermediate storage and broadcast servers. [0035] One or several control units can be located at each patient monitoring site, the control units receiving video, audio, and medical data from one or more video, audio, and medical monitoring devices in communication with the control units. The control units receive time data from a time server in communication with the respective control units. The control units encode time information with the video, audio, and medical data, and then deliver the time stamped data to communication devices in communication with the control units. Generally, the communication devices will then encapsulate the time stamped data into packets in accordance with a preselected communication protocol, and output the packets onto a network. The time stamped data may be sent for storage on an intermediate server, or it may go directly to a selected medical monitoring site, or both events will generally occur. [0036] A network connection is provided between the communication devices in communication with the audio, video and medical device control units, to allow time stamp information to be communicated between the respective control units. [0037] A plurality of medical monitor control units are located at one or more medical monitoring sites, the control units being in communication with a communication device. The communication device selectively requests and receives time stamped data packets from one or more intermediate storage servers on the network. The task of the communication device is to de-encapsulate the time stamped data packets to reconstruct time coded medical, audio and video data from one or many control units at the patient monitoring site. [0038] There may be one or more intermediate servers connected to the network, which receive, store, retrieve and transmit the time coded audio, video or medical data.

[0039] Medical monitoring site control unit software is provided to construct time synchronized representation of data from one or many medical device control units for further display or processing purposes.

BRIEF DESCRIPTION OF THE DRAWINGS:

[0040] The novel features which are believed to be characteristic of the present invention, as to its structure, organization, use and method of operation, together with further obj ectives and advantages thereof, will be better understood from the following drawings in which a presently preferred embodiment of the invention will now be illustrated by way of example. It is expressly understood, however, that the drawings are for the purpose of illustration and description only and are not intended as a definition of the limits of the invention. Embodiments of this invention will now be described by way of example in association with the accompanying drawings in which: [0041 ] Figure 1 is a general schematic of a distributed system in keeping with the present invention; and

[0042] Figure 2 is a further general schematic showing an alternative distributed system in keeping with the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS:

[0043] Referring now to Figure 1 , a typical arrangement of a distributed system in keeping with the present invention is illustrated. Here, the major components comprise a patient monitoring site 12, a typical medical monitoring site 14, a typical intermediate server 16, and a communication network 18. Generally, any distributed system in keeping with the present invention will comprise a plurality of patient monitoring sites 12; and as shown, it will also comprise a plurality of medical monitoring sites 14a through 14n, and a plurality of intermediate servers 16a through 16n. Each medical monitoring site 14 includes at least one output device 15. Each patient monitoring station 12 includes an output control device 17, by which selected audio, video and medical data are output; all as noted hereafter.

[0044] Within the patient monitoring site 12, there may be a plurality of input devices by which selected audio, video, and medical data are captured for a patient. Audio capture devices are shown at 20a through 20n; video capture devices are shown at 22a through 22n; and medical data devices are shown at 24a through 24n. A time server is shown at 26, and it provides a base time signal which is referenced by all of the input devices so as to provide a synchronized time stamp on all the data captured by the plurality of input devices - all of which data is then output through an output control device 17 to the network 18, through a plurality of network connections shown generally at 30. [0045] Also shown in the patient monitoring site 12 are an audio playback control unit 32 and a video display control unit 34. These permit bilateral communication between any input device 19 at any medical monitoring site 14 and the patient monitoring site 12, so as to provide for communication between a doctor or other caregiver who may be located at a medical monitoring site 14, and the patient who is located at the patient monitoring site 12. [0046] Thus, audio, video and/or medical data can be selectively output from any medical monitoring site 14, at its respective output device 15, for at least some selected patient monitoring site 12, in synchronization based on the time stamp from the time server 26. [0047] Figure 2 shows another general layout for a distributed system in keeping with the present invention. Here, there are a plurality of patient sites 12a through 12n; and the time server 26 is shown as being separately located away from, and thus not part of, any individual patient monitoring site 12. However, the time server 26 is in close physical proximity to the patient monitoring sites 12 so as to ensure accurate synchronisation of the time stamp on all data captured by the plurality of the input devices at the plurality of patient monitoring sites. Put in other words, the close proximity of the time server 26 through the patient monitoring sites 12 precludes the likelihood of any delay artifacts that might otherwise occur as a consequence of network transmission of packetized, encapsulated data. [0048] Also shown in the distributed system illustrated in figure 2 is an administrative site 40. The administrative site 40 may serve a number of different purposes; included among them may be the maintenance of patient billing records and the like. The administrative site may also be such as to allow for the intervention of a supervisory caregiver who might, for example, have the option of initiating drug administration to a patient at a patient site using bilateral communication with a drug administration device of some sort located at the patient monitoring site.

[0049] Other modifications and alterations may be used in the design and manufacture of the apparatus of the present invention without departing from the spirit and scope of the accompanying claims. [0050] Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not to the exclusion of any other integer or step or group of integers or steps.

Claims

WHAT IS CLAIMED IS:

1. A distributed system for acquiring, disseminating, and outputting audio, video, and medical data, said system being c h a r a c t e r i z e d by: at least one patient monitoring site (12a, 12b, 12c, 12d, 12e, 12f, 12g, 12h, 12i, 12j, 12k, 121, 12m, 12n) comprising a plurality of input devices (20a, 20b, 20c, 20d, 20e, 20f, 20g, 20h, 20i, 20j, 20k, 201, 20m, 20n, 22a, 22b, 22c, 22d, 22e, 22f, 22g, 22h, 22i, 22j, 22k, 221, 22m, 22n, 24a, 24b, 24c, 24d, 24e, 24f, 24g, 24h, 24i, 24j, 24k, 241, 24m, 24n) by which selected audio, video and medical data are captured for a patient; at least one time server (26) to provide a base time signal which is referenced by said plurality of input devices at each said at least one patient monitoring site, so as to provide a synchronized time stamp on all data captured by said plurality of input devices, wherein each patient monitoring site is associated with a respective time server; at least one medical monitoring site (14a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j, 14k, 141, 14m, 14n) comprising at least one output device (15) at which audio, video and medical data can be selectively output for at least one selected patient monitoring site, in synchronization based on said time stamp; and a network (18) to which said plurality of input devices and said at least one output device are connected; whereby a selected medical monitoring site may contemporaneously receive, review and analyze synchronized audio, video and medical data from at least one selected patient monitoring site.

2. The system of claim 1, wherein each said at least one patient monitoring site is located in physical proximity to its associated time server to ensure accurate synchronization of said time stamp on all data captured by said plurality of input devices.

3. The system of either of claims 1 or 2, wherein said patient monitoring site further comprises at least one output device (17) by which selected audio, video and medical data are output.

4. The system of any of claims 1, 2 or 3, wherein said medical monitoring site further comprises at least one input device (19) by which selected audio, video and medical data may be input so as to provide bilateral communication between the medical monitoring site and the patient monitoring site.

5. The system of claim 1, further' comprising a system for acquiring, disseminating, and outputting audio, video, and at least one intermediate server (16a, 16b, 16c, 16d, 16e, 16f, 16g, 16h, 16i, 16j, 16k, 161, 16m, 16n) for selective storage of data captured by at least selected input devices from selected patient monitoring sites.

6. The system of claim 5 , wherein a selected medical monitoring site may receive, review and analyze stored synchronized audio, video and medical data from at least one selected patient monitoring site from said intermediate server.

7. The system of either of claims 5 or 6, wherein there are a plurality of intermediate servers, wherein each of said intermediate servers stores data from a selected specific input device at each patient monitoring site.

8. The system of any of claims 5, 6 or 7, wherein there are a plurality of intermediate servers, wherein each of said intermediate servers stores data from a selected group of patient monitoring sites.

9. The system of either of claims 1 or 5, wherein said network is chosen from the group of network means consisting of local area networks, wide area networks, intranet, internet, extranet, wireless wide area networks, wireless local area networks, cable TV networks, asynchronous transfer mode networks, public switched telephone networks, integrated services digital networks, infrared networks, microwave relay networks, satellite uplink and downlink networks, and combinations thereof.

10. The system of either of claims 1 or 5, wherein at least one input device at said at least one patient monitoring site comprises a medical transducer arranged to derive an analog signal indicative of a selected physiological condition of a patient, an analog to digital converter, and a microprocessor unit arranged to control digitization of the derived data from said transducer and to control the transmission of said data to said network.

11. The system of claim 5, wherein software required to store, process, and display data from any patient monitoring site is stored in an intermediate server, and is uploadable therefrom to any medical monitoring site.

12. The system of either of claims 5 or 11 , further comprising at least one administrative site (40) in communication through said network with at least one selected patient monitoring site and at least one medical monitoring site.

13. The system of either of claims 1 or 5 , wherein a plurality of medical monitoring sites, each having a medical caregiver stationed thereat, are simultaneously connected to a single patient monitoring site.

14. The system of either of claims 2 or 5, wherein each time stamp is placed with each respective data stream before the data stream is connected to said network.

15. The system of either of claims 1 or 5, wherein data which is transmitted from a patient monitoring site over said network is encapsulated for packet transmission.

16. The system of claim 5, wherein data which is transmitted from a patient monitoring site over said network is encapsulated for packet transmission.

17. The system of claim 16, wherein a control unit is located at each medical monitoring site, to receive packets of data from a selected intermediate server so as to de-encapsulate the data and to reconstruct time coded audio, video, and medical data in accordance with the time stamps associated therewith.

18. A method of acquiring and transporting audio, video, and medical data in a distributed system therefor, comprising the steps of:

(a) establishing at least one patient monitoring site (12a, 12b, 12c, 12d, 12e, 12f, 12g, 12h, 12i, 12j, 12k, 121, 12m, 12n) to acquire audio, video, and medical data from a patient at that site;

(b) encapsulating the acquired data for each patient at each patient monitoring site and placing a time stamp from a common time server (26) on all data;

(c) outputting the data to a network (18);

(d) acquiring the encapsulated data from the network at a medical monitoring site (14a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j, 14k, 141, 14m, 14n); and

(e) de-encapsulating selected data from a patient monitoring site at a medical monitoring site so as to review and analyze that data in synchronization, based on the time stamps therein.

19. The method of claim 18, wherein step (c) includes the step of outputting data to at least one designated intermediate server (16a, 16b, 16c, 16d, 16e, 16f, 16g, 16h, 16i, 16j, 16k, 161, 16m, 16n) in communication with said network.

20. The method of claim 19, wherein step (e) is carried out at a time later than the time when said data is generated.