WO2000003526A1 - System and method for establishing and retrieving data based on global indices - Google Patents

Abstract

A system and method for establishing and retrieving data based upon global indices established on the date of first use by a user. The system uses a distributed data name service (DDNS) which uniquely identifies users of the system based upon the unique ID of devices on the system combined with the date and time of first use by the user. Both the unique device ID and the unique user ID's are stored on servers of the system. This unique user ID generated is used for all subsequent uses of the system by the user. Searching for data generated by devices of the system relating to a particular user is accomplished by searching for instances of the user ID on servers of the system rather than by searching for the data itself. A simplified data transport protocol allows for the transfer of data from one location to another after the data is located.

Description

Title: System and Method for Establishing and Retrieving Data Based on Global Indices

Field of the invention

This invention relates generally to storage to data and retrieval of records. More

particularly this invention relates to a universal method for generating an index of medical

records at the time services are rendered and retrieving medical records based upon the

automated indexing performed, Background of the invention Medical records can reside in many different places. As a patient sees different

doctors and is treated for different conditions, individual records relating to the patient are

created in each individual location. Therefore a medical record could exist at a general

practitioner where the patient goes for annual physicals. At another time a medical record

could be created for the patient at an immediate care facility where emergency room services are rendered. In a similar fashion a medical record for the same patient could be created at a particular specialist's office who treats the patient for a particular condition. All of these

medical records may be critical to the treatment ofthe patient in any particular circumstance. If the total medical record for individual patient is not available, certain diagnoses may be overlooked or erroneously made.

Several systems have addressed the issue of how to create universal medical records.

In general these systems create medical records by the creation of a file in some central

storage area. Thereafter the central storage area may be accessed by individual practitioners

by accessing the central storage ofthe medical record. Such systems use a "root registration" system wherein medical records and identities are registered centrally. Such systems generally are not fully automated leading to the potential for errors. Further only "registered" records are available to remote users. Thus if a patient's medical record is not centrally

registered, it is simply not available to the practitioner.

Another disadvantage ofthe central registration process is that, at the present time, no

single format is universal. Thus many different medical organizations have different formats

which cannot be accessed among different medical institutions. Even if such access is

granted, format translation programs must be used which could cause additional errors in

translation.

One example of a system which attempts to obtain a master index of patient

identification information is the telemed system in use at Los Alamos labs. That system

maintains a master index of patient ID's thus tracking patient ID as a master reference. The master ID is then used to determine where to find data related to a particular patient.

Telemed system deals with topological information normally characterizing patient records.

Further, the system relies upon "middleware" to resolve differences between database systems

that possess a particular patient's record. Thus a translation mechanism is necessary. Further, the telemed system still requires a master patient index as a form of central registration.

In contrast to the systems noted above, the present invention does not rely on a root

registration or a central registration of client information. Rather, the present invention

establishes an identity for a patient at the time of service, based on the identity of a given device. This identity is established at the location ofthe device and not at any central location. This identity is designated, however, in a universal fashion such that, for patient's

whose identity is established by the system, information relating to that particular patient can

be looked up in a convenient manner. Further, the present invention comprises the data transfer protocol to allow for global addressing and retrieval of information from sites remote from the location at which the patient is present. In this matter, all information concerning a particular patient maybe retrieved by the location treating the patient.

Brief description of the invention It is therefore and objective ofthe present invention to be able to locate information

by searching for indices of that information rather than for the information itself.

It is a further objective ofthe present invention to establish device driven unique

identifiers that identify a person using the system. It is a further objective ofthe present invention to establish device driven unique

identifiers that identify a objects that are the subject of transactions using the system.

It is yet another objective ofthe present information to establish a global identifier for

a user ofthe present invention the first time that a user uses the present invention. It is yet another objective ofthe present information to establish a persistent identifier

for a user ofthe present invention the first time that a user uses the present invention.

It is a further objective ofthe present invention to uniquely identify a particular device

connected to the system. It is yet another objective ofthe present invention to establish device identification the first time that a device is activated on the system.

It is a further objective ofthe present invention to make data universally available as soon as that data is created on the system.

It is another objective ofthe present invention to make data available at sites remote

from the location at which the data is created as soon as the data is created. It is yet another objective ofthe present invention to be able to search for data of interest without knowledge ofthe format in which the data was originally created. It is a further objective ofthe present invention to allow local sites where data is created to establish their own formatting and storage policies without such formatting and

storage polices being dictated by a central facility.

It is yet another objective ofthe present invention to establish security for a users

records by separating the user records from the identification card issues to a user.

The present invention uses a device-based paradigm to avoid the confusion and restrictions associated with root registration systems. For example, a particular manufacturer

would register its company for participation with the present invention. Identification

numbers are assigned by the manufacturer and used to designate the equipment in question.

Thus equipment from a particular manufacturer which is used by a particular practitioner or

health care provider has a unique ID. A date/time stamp is also added to this equipment ID to designate the source and when the equipment is used.

The present invention also comprises a simple network transport up protocol, defined

in this application as the Simple Data Transfer Protocol or SDTP. The SDTP provides Internet wide sharing of data and database systems through a client/server, transaction based

model of data interaction and management. The SDTP allows for the transmission, reception, and recovery of data from disparate locations.

The present invention also provides a network delivery mechanism for addressing

where to find requested information. This subsystem known as the distributed data name

service or DDN S is the reference system by which SDTP operates. This is not meant however as a limitation. Once the location of information is established by the DDNS, retrieval of information could occur equally as well by any protocol once that protocol knows

the location ofthe desired information.

Various universal encoding systems are also used in the present invention so that

individual devices and users of those devices can be encoded in a universal fashion. It should be noted that the preferred embodiment illustrated in this specification is that

of a medical device and data retrieval system. However, the present invention should not be

construed as being so limited. For example the architectures and topology ofthe present

invention is equally well suited to commercial transactions such as point of sale transactions,

the generation of ATM cards and other commercial ventures. It can also be sued as a form of

identification for employees of large organizations where security and access to facilities in disparate locations must be tightly controlled. Thus while the medical application will be elucidated below, those skilled in the art will appreciate that the system and method described

can be applied in many disparate situations.

Using the present invention, device manufacturers register their own unique names

with the system. For example Hewlett-Packard may register the name "HP" to be used with

all of its device ID numbers whereas another manufacturer such as Phillips might register another different name "PH." When a medical device is first used on the system, its own

identification (manufacturer, and device ID number) is automatically registered with the

system. A patient receives an ID number, the first time the patient receives an ECG or is x-

rayed by equipment that is registered with the system ofthe present invention. Thus the first time a patient is examined via medical equipment ofthe present invention, a universal record of not only the equipment, but also the patient is automatically created. The present invention also comprises a user identification token or barcode label

placed on any card of any variety which may be in the form of a credit card, smart card or

other token card which is generated at the time ofthe first use of any device registered with

the system. From that point on, the patient identification card is "registered" within the system. Further, the health care provider simply uses the imaging equipment available based upon the patient identification card, the universal encoding ofthe system, and images recorded with appropriate patient identification information and image information. In

addition, the image created is universally available immediately after creation.

After recording information, the present invention tracks indices to locations of information. If the location ofthe device changes, that information could be tracked by the

DDNS level 1 server so that queries could be automatically rerouted to the location at which

the device is currently housed. Thus the information can change as necessary while the index

to access that information does not. The present invention also does not require standardized

formatting of information. Thus, local sites format and store their own information as they

desire without having to adhere to a particular dictated format. Thus local sites do not have

equipment, staffing, administration, and other matters imposed upon them. The system ofthe present invention transports, sends, delivers, receives, and

processes information objects. No middleware is required. Transmission of request for

information and the receiving of that information is done, using the simplified data transfer

protocol. In addition, existing systems can be included within the present invention since any kind of document or object can fit within the present invention as an object. Only namespaces as addresses are necessary for the present invention in order to find the location

of desired information and retrieve that information.

In summary, the present invention is a device driven addressing system rather than a

top-down addressing system. Individual devices create the namespace address necessary to retrieve information created by the individual device. Thus the present invention allows the minimal set of possible information at the top-level, which is used for routing requests for information, with actual information created by individual devices or sites stored and located at those devices or sites.

The present invention comprises a Simple Data Transport Protocol (SDTP), Distributed Data Name Service (DDNS) software implementation, and a paradigm for automated indexing of global databases. The DDNS design is similar in function to the domain name service which supports

all Internet addresses. The domain name service for the Internet allows a single address to be

used by any user regardless of that user's location to find another user on the Internet. In a

similar fashion the DDNS ofthe present invention supports such a lookup service. However

DDNS is generalized and optimized for resolving database locations and database service

locations. The DDNS exists in a series of servers in a tree structure whereby medical diagnostic

equipment are connected to servers. These lower level servers are in turn connected to higher

level servers in a tree structure or parent-child relationship. There is no practical limit to the

level of servers in the tree structure. It is only required that there be sufficient levies of

servers to satisfy the query needs ofthe organizations connected to the DDNS network.

Using the DDNS ofthe present invention, if a client machine requires information it

does not have, it sends a query to a parent server concerning where to find the record

information. In this application, the parent server is referred to as a DDNS Level 2 server or

DDNS-2 server. This situation can exist in the medical sense if a patient, having a medical ID card ofthe present invention, visits an emergency room in other than the patient's home city. In that situation the patient may use the patient ID card which will not be recognized by

the local medical diagnostic equipment. In that case the medical diagnostic equipment will

query the next higher server regarding where to find information on the patient.

If the server being queried has the necessary information, and answers the requesting

client, the Interaction stops. If the server does not have the information, it in turn, asks its parent server, and so on up a tree structure of parent-child DDNS servers until the requested information is found. Once the patient index information is found, it is passed back down to

the originating client which receives address/index information for a direct site to site request.

At this point a peer-to-peer connection can be made whereby the client receives the desired

medical information directly from the medical diagnostic equipment or database possessing that information.

The Simplified Data Transport Protocol (SDTP)

Once the source ofthe desired information is located it becomes necessary to transfer

the desired information from one location to another. The Simplified Data Transport

Protocol (SDTP) ofthe present invention has this task. SDTP provides Internet- wide

sharing of data and database systems through a client-server, transaction-based model of data

interaction and management. SDTP structures transmission, reception, and recovery of data.

Brief Description of the Figures Figure 1 illustrates the DDNS server nodes Figure 2 illustrates a DDNS network topology

Figure 3 illustrates a specific example of an instance of use ofthe DDNS network topology Detailed Description of the Preferred Embodiment

As noted earlier, the present invention comprises a Distributed Domain Name Service

(DDNS) software implementation whereby devices and users are uniquely identified and

registered on servers ofthe system the first time the devices are used and the first time that

users use the devices, a Simple Data Transport Protocol (SDTP) whereby once data of interest is located, that data can be transported from location to location with ease, and a paradigm for automated indexing of global databases.

Distributed Data Name Service (DDNS) Distributed Data Name Service (DDNS) provides a name lookup service for the indexing of global databases. It is designed to work in between a transfer protocol such as SDTP, and an encoding scheme for naming objects uniquely.

The DDNS implementation is similar to DNS (Domain Name Service), which

supports all Internet name lookup service. The basic idea is illustrated in Figure 1 DDNS

Nodal Indexing.

In DDNS, if a client machine needs information it does not have, it asks a parent

server where to find that information. If that server has the information, it answers the requesting client and the interaction stops. If the server does not have the information, it in turn asks its parent server, and so on, up a tree structure of parent-child DDNS machines,

until the requested information is found. Once the information is found, it is passed back

down to the originating client, which receives forwarding information for a direct site-tosite request, at which point a peer-to-peer connection is made "horizontally" in the tree structure.

It is important to note that, strictly speaking, DDNS is not "Middleware". Although it can appropriately interact with Middleware as necessary.

DDNS provides efficient recovery of records from anywhere on a network, and has no

machine-type or operating system restrictions whatsoever. Its architecture provides intrinsic scalability suitable for supporting universal databases that may require diskspace exceeding

current technologies for individual sites. Since it resolves namespaces rather than IP

addresses, DDNS will seamlessly migrate to new network protocols such as "IP2" whenever

traditional IP is replaced. Using namespaces also supports organizational durability, since

organizations may change names and have these reticulated through the DDNS structure, or

keep the same names and change the undergirding machine hardware supporting those names without impact of data accessibility to the network. The SDTP/DDNS combination provides an automatic, low-level addressing and retrieval mechanism on which other functionality can be conveniently built. Such

functionality may include automatic invoicing, automatically generated statistical polling of

part quality, demographic information for illnesses without access to patient identity, etc.

Such functionality supports electronic interaction and electronic commerce.

Used with SDTP and other naming and classification conventions, DDNS can provide global indexing of any kind of image, produced on any kind of image-producing device,

making any image retrievable by a click of a barcode reader. Yet images may be produced on

different machines in different countries. Implications of such design specifically include

SDTP/DDNS/ASIA support for universal image recall through standard medical cards given

to patients at local hospitals. This is discussed specifically elsewhere in the document.

Used with other encoding schemes, SDTP/DDNS functionality may conveniently extend

into diverse applications. Such applications may include automated part tracking, automated

consumer purchase and repurchase, automated manufacturer-retailer profit distribution, and

automated assessments of production quality on a plant-by-plant basis. The major advantages supporting DDNS design include:

1. Machine interactions are name lookups, not actual data transfers, until the very

last moment when a site-to-site connection can be made. Thus, interactions are very fast between machines.

2. Information contained on any machine emphasizes minimalist storage. A machine attempts to keep only the most minimal information it needs on its local system, knowing that it can retrieve remote information very quickly whenever needed.

3. Storage of data is genuine distributed. Since DDNS servers only hold index

information for where to get information, rather than the information itself, global databases can be unlimited in size. Even very large global databases that exceed the physical storage possibilities of single sites will have excellent performance.

To illustrate the benefits, consider an example in which local sites cannot usefully

store more than 50 terabytes of information. Since a global database supported by

SDTP/DDNS only stores addressing information, it can provide information on many such

sites, letting those sites resolve the actual data internally. 4. Each machine may cache its previous lookups and thus avoiding vertical

lookups for recurrently used data. For data that sister sites will share over and

over, the caching mechanism allows site-to-site connections without making

parent-node queries. Thus, performance is very fast, even when scaling to very large addressing mechanisms.

5. Local policies determine disk storage and internal data structure for local

systems. Yet local information will be available globally.

Flexibility & Ease of Use

Flexibility, generality, and ubiquitous accessibility are core principles ofthe

SDTP/DDNS implementation. With a minimal "backbone" infrastructure of a small collection of machines, DDNS can support numerous concurrent universal databases, conveniently supporting as diverse systems as automated parts tracking in automobile repairs,

insurance records, and purchase and repurchase of any scanable item: clothing, home

appliances, wood, paint, groceries, etc. Such applications will only require a barcode click on behalf of the user. And then on behalf of that user, a computer queries a DDNS server for data location, and then SDTP retrieves the data from the appropriate site.

Simple Data Transport Protocol (SDTP) The following terminology and associated definitions are used in this specification:

Database: A collection of records. SDTP supported databases can be local and/or

global.

Record: A denotatum stored in a database.

Transaction: An interaction between a client query and server response. Example

transactions include modifying a global database and finding a record

in a database.

Client Query: A request from a client sent to a server.

Server Response: A response from a server sent to a client.

Message: Generally, a client query or server response. Specifically, a content

identifier and data object.

Content Identifier: The first string of a SDTP message that identifies SDTP/0.9

version, command, and arguments to process.

Data Object: A header and body. Data objects may include text, images, video, sound, etc.

Header: Header information in a data object, employing MIME conventions.

Body: Body information in a data object, employing MIME conventions.

The Simple Data Transport Protocol (SDTP) ofthe present invention is a protocol that applies to dynamically distributed, Internet- wide, database systems.

The SDTP protocol provides universal addressing of database systems, and universal search and retrieval of data stored on such systems. SDTP supports any encoding

mechanism, but is optimized for large scale or universal encoding mechanisms for universal image tracking. SDTP distributed database functionality can seamlessly traverse any network topology, machine-type, operating system, database system, etc. The protocol supports all

forms of data: text, image, video, sound, etc. SDTP permits intelligent, efficient, fully automated data-sharing on a site-to-site,

device-by-device basis, searching and retrieving specific data sets. Data sets can be located

anywhere on a network, and have no physical storage-size restrictions. Searching can be

local or global. For example, data produced by an ECG machine in Chicago is available to

another ECG machine in Bangkok. In SDTP data are no longer viewed as existing on a single system, or any collection of

explicitly linked systems or sub-systems, such as credit card authorization systems. Rather,

SDTP views data as query relations, in which a single, very simple query mechanism

dynamically organizes and retrieves germane information at a moment of request. The basic mechanism works such that when a client query is fully satisfied locally, a search can halt. When a client query is not satisfied locally, within a couple of network

"hops" a SDTP server response will return a comprehensive list of data locations to the

requesting client. A given client needs no initial knowledge that related data even exist, or

where or how such data are stored. Yet for any given record, a client query can rapidly find

all related records across the Internet-even if related records exist on databases unknown to exist by the requesting client, at the moment of its request. SDTP can support machine clusters, LANs, WANs, heterogeneous networks,

collections of linked networks, or any set of these. This design explicitly includes support for

full, Internet-wide search and retrieval of records. Essentially, there are no network restrictions for SDTP; it can transport and retrieve information for local or global systems alike.

SDTP operations rely on client-server transactions. A transaction is characterized by a client sending a message to a server, and the server sending back a message to the client.

SDTP/0.9 supports two basic transactions, Lookup and Modify, each of which has two

commands. Table 2 summarizes these relations. Lookup index Retrieve a record's index, but not the record itself query Retrieve a record.

Modify ADD Add a record to a database. DELETE Remove a record from a database.

Table 2: Transactions

Since SDTP applies to any kind of database, existing anywhere on the Internet, SDTP transactions provide genuinely global searching, retrieving, adding, and removing records

from universal databases. As noted earlier, a message is a client query or a server response. The data structure

of messages consists in a content identifier and data object. Table 3 summarizes these

relations. A content identifier identifies SDTP version, command, and any arguments. A data object Content Identifier | _J Data Object j Header I Body

Table 3 : Message Data Structure

consists in a header and body, both of which support MIME conventions. A header contains

information about the transaction-type and data specifications. A body contains data, which can include MIME multipart documents, among other data. SDTP relies on uniform interaction between clients and servers, transacted through

client query and server response messages. A client query requests actions from a server. A server response answers client queries, and sometimes also performs actions on behalf ofthe client called server actions. Both client queries and server responses rely on the data structure

of messages.

Table 4 summarizes protocol relations. Since transactions are interactions between

client queries and server responses, a 'Lookup index' transaction would involve an exchange

between a client query and a server response. In turn, client queries and server responses are

subject to content identifiers and data objects. Transactions Lookup index query

Modify ADD

DELETE

Client Query Content Identifier Data Object Header Body Server Response Content Identifier Data Object Header Body

Table 4: Protocol Relations

Message Data Structure

A message is a content identifier and a data object. The SDTP client query content

identifier syntax is:

SDTP/version command argument ...

These expansions describe content identifier semantics: version SDTP version number. command Keyword specifying SDTP activity. argument Argument for command. Subsequent arguments.

Example. Consider this legal content identifier:

SDTP/0.9 LOOKUP Medlmages 123.abc

Following the content identifier syntax, the command is 'LOOKUP' with two

arguments: (l)'Medlmages' (the database to search) and (2) '123.abc' (a record or set of records as might occur in a hospital system). A data object includes (1) a header and (2) a body. A data object may include text,

images, video, sound, any other media or data type, and any combination thereof.

A header consists in one or more lines and is terminated by a blank line. The syntax

for such lines is: fieldname: data

The argument data may have any number of additional arguments separated by

semicolons (';'). These expansions describe the header semantics:

fieldname Label for data field (e.g., Date, Content-Length,Content-Type, etc.) data Data (e.g., for content-type, cookies etc.)

Client query data object headers additionally can contain preferences for server responses, but SDTP/0.9 does not yet specify these.

For example, consider the following data object header. This example illustrates a

Lookup transaction that retrieves a record:

Content-Type: application/sdtp; transaction ="lookup-l "; lookuptype - 'query" A body consists in a MIME body, including multipart bodies [FB96a]. This structure facilitates transmission of all data types such as text, graphics, sound, video, etc.

A body contains content or is null. The exact format ofthe body depends upon

specific databases, and thus is fixed in a separate standardization process not subject to SDTP.

For example, consider the following data object body. This example indicates a successful deletion of record '123. abc':

SUCCEEDED DELETE 123. abc

A client query is a message, and consists in (1) a content identifier and (2) a data object. An example of a client query data object is: Content-Type: application/sdtp; transaction="modification" From: medical.cenon.com

DELETE 123. abc ADD DEF0456

A server response is a message, and consists in (1) always a data object, and (2) sometimes an additional server action (e.g., a record deletion). See also Message Data

Structure.

Unlike client queries, SDTP server responses have no content identifier. Server

responses are data objects.

Server response data object headers are transaction types. For example, consider the following server response data object header. The Transaction type illustrates address forwarding. Content-Type: application/sdtp; transaction= "forwarding"

The Server response data object body syntax is determined in the data object header according to the transaction specification. A body contains content or is null. For example,

consider the following server response data object body which illustrates successful deletion

of record '123. abc', and failed addition of record 'DEF@456'. SUCCEEDED DELETE 123.abc FAILED ADD DF.FO456

Example Server Response Data Object Consider this example of a server response data object, including both header and body:

Content-Type: application sdtp; transaction="modification" From: medical.cenon.com SUCCEEDED DELETE 123. abc FAILED ADD DEF@456 A server response may invoke a server action, such as adding or deleting a record

from a database. SDTP specifies the structure and syntax of data objects. SDTP specifies a

semantics associated with the server action, but not structure or detail of implementation.

Such considerations axe left to decisions of site-by-site implementation.

Transactions A transaction consists of (1) a client query (to server), and (2) a server response (to

client). The current version, SDTP 0.9, provides two types of transactions, Lookup and

Modify. Table 5 illustrates these relations. Client Query Server Response Lookup Client queries server Server returns records, for records. or location instructions for where to find records. Modify Client requests server Server synchronizes data synchronization storage.

Table 5: Transaction Summary Lookup: A Lookup transaction determines if a node has knowledge of requested record(s). Client Query: A Lookup client query is a message, and thus contains (1) a content identifier

and (2) a data object.

(1) Content Identifier: An sample Lookup content identifieris as follows: SDTP/0.9 MODIFY Medlmages 123.abc (2) Data Object: A Modify data object will contain (A) a header and (B) a body.

(2 A) Header: The Lookup header uses a Content-Type that specifies (1) a Lookup transaction

and (2) a lookuptype. A Lookup data object header has syntax:

Content-type: application/sdtp; transaction="lookup"; lookuptype="ty/?e" 'type 'in 'lookuptype' has these values and meanings in SDTP/0.9: Value Meaning query Transfer a record index Transfer a record's index, but not the record itself The following example of a Content-Type data object header retrieves a record's

index, but not the record itself: Content-Type: application/sdtp; transaction="lookup"; lookuptype=-"index"

(2B) Body: A Lookup client query data object body is empty in SDTP/0.9.

Server Response: A Lookup response (1) has no content identifier, and (2) has a data object.

(1) Content Identifier: The Lookup server response has no content identifier.

(2) Data Object: The Lookup server response data object has (A) a header and (B) a body.

(2 A) Header: This header specifies the Content-Type ofthe server response, but may also

include other information such as MD5 encrypted signatures, etc.

(2B) Body: The body follows MIME message body conventions [FB96a]. SDTP data object bodies have three forms:

1. One or more records, structured as MIME multipart documents [FB96a].

2. Forwarding instructions, for one or more records, structured as the MIME type

application/sdtp with attribute transaction set to forwarding. For example: Content-Type: application/sdtp; transaction="forwarding"

A following data object body would contain a list of addresses to query for records. 3. Compound responses, structured as MIME multipart documents. Each part of a multipart document will be: (a) Form 1, One or more records (b) Form 2, Forwarding instructions (c) Form 3, Compound responses. Example Lookup Transaction: This example illustrates a Lookup transaction, in which

record '123.abc' is retrieved from universal database 'Medlmages'. The transaction consists in a client query and a server response.

Client Query: The following 3 line transcript is a plausible client query Lookup record

retrieval request, from medical, cenon.com. SDTP/0.9 LOOKUP Medlmages 123.abc Content-Type: application/sdtp; transaction- 'lookup"; lookuptype- 'query" From: medical.cenon.com

This query requests the retrieval of record '123. abc' from universal database

'Medlmages'.

Server Response: The following 7 line server response indicates a plausible server reply to

the previous client query.

SDTP/0.9 LOOKUP Medlmages Content-Type: application/sdtp; transaction- 'forwarding" From: medical.cenon.com

ddns-2.uch.net ddns-2.mag.net ddns-2.nyc.net The server forwards the client addresses where questions are answered about record '123. abc' in universal database 'Medlmages'.

Modify: A Modify transaction synchronizes databases. A client query asks for modification of server-stored data, such as adding or deleting a record.

Client Query: A Modify client query includes (1) a content identifier and (2)a data object. (1) Content Identifier

See Content Identifier about content identifier syntax and semantics. An example Modify

content identifier looks like: SDTP/0.9 MODIFY Medlmages 123.abc

(2) Data Object See Data Object about data object syntax and semantics. A Modify data object will contain (A) a header and (B) a body.

(2 A) Header. A Modify data object header specifies a Content-Type using

transaction- 'modification". An example looks like:

Content-Type: application/sdtp; transaction- 'modification" (2B)Body. TheModifydataobjectbodycontainsinstructionsdetailingmodification ofthe database,

such as adding and deleting records. An example data object body request for deleting record

'123.abc' and adding record 'DEF@456' could be:

DELETE 123. abc ADD DEF@456 S erver Response A Modify server response (1) has no content identifier, and (2) has a data object. (1 ) Content Identifier The Modify server response has no content identifier.

(2) Data Object

See Data Object about data object syntax and semantics. The Lookup server response

data object has (A) a header and (B) a body. (2 A) Header. This header specifies the Content-Type of the server response, but may also include other information such as MD5 encrypted signatures, etc.

(2B) Body. The body follows MIME message body conventions [FB96a]. The Modify data obj ect body may also contain verification information, such as the success or failure of a request. Verification information often is null. Example Modify Transaction The following example illustrates a Modify transaction. This example modifies the

universal Medlmages database, where the client query requests to delete record 123. abc and to

add record DEF@456. The transaction consists in a client query and a server response.

Client Query. The following 6 line transcript requests to delete and add a record from

database Medlmages. SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: medical.cenon.com

DELETE 123. abc ADD DEF@456 Line 1. Client query identifies protocol and requests modification of database Medlmages. Line 2. 'Content-Type'identifies a SDTP application; 'transaction' specifies a "modification"

transaction type.

Line 3. 'From' identifies client making request.

Line 4. Blank line identifies separation between data object header and data object body.

Line 5. 'DELETE' removes forwarding for Lookup query of record '123. abc'.

Line 6. 'ADD' enables forwarding to 'medical.cenon.com', for Lookup query of record 'DEF@456'.

Server Response. The following 6 line server response indicates a plausible reply to the previous client query.

SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: medical.cenon.com SUCCEEDED DELETE 123. abc FAILED ADD DEF@456

Line 1. Server response identifies protocol and acknowledges request for modification of database Medlmages . Line 2. 'Content-Type' identifies a SDTP application; 'trisection' specifies a

"modification" transaction type. Line 3. 'From' identifies client making request.

Line 4. Blank line identifies separation between data object header and data object body.

Line 5. 'SUCCEEDED' indicates that client query 'DELETE' was completed successfully.

Line 6. 'FAILED' indicates that client query 'ADD' was not completed successfully. Referring to figure 1 a simplified DDNS Nodal indexing system is illustrated. If the

electrocardiogram analyzer 10 has unique identifier which, for purposes of this illustration is

noted as the number one. When a user first is established with the system of the present

invention the user might be subject to electrocardiogram analyzer testing on, for example,

January 11th 1998. This date, in combination with unique electrocardiogram analyzer identifier

"one" is then registered was in DDNS server 14 and. In this example the DDNS server is noted as a Level-2 server located at the University of Chicago noted with the abbreviation "UCH."

Other electrocardiogram analyzers 12, 16, and 18 are also shown as part ofthe system.

Electrocardiogram analyzer 12 is connected to DDNS server 14. Electrocardiogram analyzer 16

is connected to DDNS server 20 which, in the present example is noted as being associated with

Massachusetts general hospital, abbreviated as "MAG. " . Electrocardiogram analyzer 18 having the unique identifier "4" is connected to DDNS server 22 in New York City.

DDNS level 2 servers 22, 20, and 14 are connected to a DDNS Level-1 server 24. The purpose ofthe DDNS Level-1 server 24 is to receive and store a record ofthe identifiers of of

individual date or records created by the individual electrocardiogram analyzers shown in figure

1. It is important to note that the DDNS Level-1 server 24 does not contain the ultimate information, that is, the results of electrocardiograms that have been administered to the particular patient at the various hospitals. (It should be noted that DDNS level 1 server may actually be serval machines as is later illustrated.) DDNS Level- 1 server 24 only contains a

record ofthe indices that show where the information is stored. Thus for example, if a patient

receives an electrocardiogram on January 11th 1998 from electrocardiogram analyzer can the

information record concerning that analysis is stored and the user is given a medical identification card possessing and ID number associated with at first examination. If that patient

is subsequently examined using electrocardiogram analyzer 18 on September 23rd 1998, the

practitioner would obtain the medical identification card ofthe patient, record that information

through electrocardiogram analyzer 18 which would then the determine if it had ever seen that

particular patient before. If not, a query would proceed from electrocardiogram analyzer 18 to DDNS Level-2 server 22 to inquire if a record of that patient exists. If no such record exists at

DDNS Level-2 server 22 that server will send a query to DDNS Level-1 server 24 to determine if it has a record of the particular patient.

DDNS Level-1 server or 24 will have such are record ofthe existence ofthe particular

patient is existing at electrocardiogram analyzer 10 which can be reached via DDNS server 14.

Thereafter DDNS Level-2 22 will make contact with DDNS Level-2 server 14 on behalf of electrocardiogram analyzer 18, with electrocardiogram analyzer 10.

In this example, DDNS servers of two different levels are shown. The level 2 servers store and broker requests for indices relating to medical equipment that is connected to them.

The level 1 DDNS servers store and broker requests for indices relating to patients from Level 2 servers connected to them. Thus information is not generally passed when a query is made, only the identification ofthe location ofthe data is transferred. It should also be noted that this example of use in the medical arena is not meant to be limiting. As will be explained later, other

application areas are equally considered to be within the scope ofthe present invention.

Referring to figure 2 the network topology of the present invention is illustrated. As noted earlier, the present invention is device driven rather than driven by a top-down

classification schemata. A series of medical devices may be attached to a workstation at a

particular hospital. For sample, ECG 4, CT 6, and ECG 12 may all be attached to a workstation

2 at a location, for example, the University of Chicago (UCH). ECG 4 will have its own unique

identifier generally assigned by the manufacturer. When the ECG 4 is first activated to perform

its first examination and creates the appropriate patient record, ECH 4 becomes registered on the

system ofthe present invention. Thus the global identifier for ECG 4 is created the first time the

device is activated. In a similar fashion, CT 6 also has a unique identifier as does ECG 12.

These devices are also shown as attached to workstation 2.

Alternatively medical devices may be self-contained and amenable to being attached or

directly connected to a DDNS server. The situation is also illustrated in figure 2 where CT 8 is

shown as directly connected to second level DDNS 14. Additionally, ECG 10 is also shown as

connected to the DDNS level 2 server 14.

All ofthe above devices ECG 4, CT 6, ECG 12, CT 8, ECG 10, and workstation 2 are all uniquely identified and registered with the system ofthe present invention the moment that

they are first activated. As will be shown later, a date time stamp is also used in conjunction with

the unique identifier to create a unique patient identifier the first time that the patient uses any device that is registered on the system.

In a similar fashion, other medical devices and other geographically disparate locations can also become registered on the system ofthe present invention. Again referring to Figure 2

ECG devices 13.15, and 16 may all be resident at, for example, Massachusetts General Hospital

(in this figure designated as MAG). Additionally, MRI 11 and CT are also shown as located in

Massachusetts General hospital. ECG 15 and 16 may be located in emergency room 21 while

ECG 13 may be located in and the attached to a workstation and cardiology 19. MRI 11 and CT 9 may be connected to workstation 17 in radiology. Workstations 21 in the emergency room, 19

in cardiology, and 17 in radiology are all connected to DDNS level 2 server 20. It is important

to note that unique identifiers will only be associated with the devices actually performing the

diagnostic task, that is, devices 9,11, 13,15, and 16. Workstations 17, 19, and 21 will not to have

unique identifiers since they will not be creating the medical records to be searched. It is of

course possible that an individual hospaital may wish to have unique identifiers regarding all devices on a network whether diagnostic or not in order to be able trace all instances of data or

information created. The present invention will support this implementation as well.

In Figure 2 yet a third location, hypothetically a hospital in New York City (designated as NYC) is shown as having a series of medical devices as well. In this is an

instance ECG 18 is connected to a PC 32. That PC is in turn connected to a display 30 was

capable of displaying the results ofthe ECG analysis. Similarly, ECG 34 is directly

connected to display 30. Display 30 is connected to a workstation 26 which has an MRI

device 28 connected to it. This workstation 26 is in turn attached to DDNS level-2 server 22.

All ofthe DDNS level-2 servers 14,20, and 22 are connected to DDNS level-1 servers

23, 24, and 25. These DDNS level-1 servers broker queries for information and client index

locations coming from the various geographic locations were a patient may be treated.

It is important to note that once a medical device is activated for the first time, its unique ID is stored at both the DDNS level-2 server and a DDNS level-1 server. This is because the DDNS Level-2 server knows about diagnostic devices connected to it and DDNS Level- 1 servers know about DDNS Level-2 connected to them. Thus the DDNS servers learn about the

diagnostic devices in different ways. Further, once a patient is treated for the first time using any medical device that is attached to the present system, a permanent designation for that patient

is created which comprises the unique identifier ofthe medical device combined with the date time stamp ofthe first treatment ofthe patient.

In practice, and as will be discussed in detail later, a patient who is treated at ECG 18 in

NYC, and who possesses a medical ID card or barcode label on any card created by the system

will cause a query to be created to determine if any other medical records exist for the patient.

Initially a query will go as high as DDNS level-2 server 22. If an index to that client's records

exists within the New York City location, that information will be sent to the operator of ECG

18. If such information does not exist, DDNS level-2 server 22 will add a new record to its

database and will send the query to DDNS level-1 servers 23, 24, and 25 to determine where a

patient index for that particular patient does exist. If DDNS Level -1 server knows about the

record, it will make a record associating the the new data record with the data record that already

exists in its database. If the patient was first treated at University of Chicago, the patient index,

derived from the medical ID card, will cause a query to be sent to DDNS level-2 server 14 which will respond with the various indices which indicate that location of records relating to the patient of interest. Examples

By way of example and to further illustrate a preferred embodiment of the present

invention, Figure 3 is presented. Since only data regarding indices to information os being searched, the system ofthe present invention responds very quickly to queries for the location

of patient information. In the examples that follow, only the date@device designation is used. In the full implementation the manufacturers ID would also be present as part of the unique identifier.

1. Jane comes the University of Chicago Hospital on 11 December 1998 for the first time, to receive her first ECG ever, where she receives a University of Chicago Hospital medical card as a normal part of her admission. Upon receiving an ECG exam, Jane's reading is automatically entered into the University of Chicago Hospital's local database system, and a printer produces a small sticker which a nurse affixed to Jane's medical card.

SDTP/0.9 MODIFY Medlmages Content-Type; application/sdtp; transaction- 'modification" From; ddns-2.uch.net

ADD 19981211@1

Since DDDS-2:UCH has never seen record '1998121 1@1', it attempts to DD' it to the

next level "up" (to DDNS-1 Servers). A similar SDTP client query is sent "up" to DDNS-1

Servers.

2. DDNS-1 Servers receive and process the following client query request to ADD record '1998121 l@l 'to the global 'Medlmages' database:

SDTP/0.9 MODIFY Medlmages Content-Type; application/sdtp; transaction-modification" From: ddns-2.uch.edu ADD 19981211@1

Since DDNS-1 Servers have not yet seen record '19981211@1' DDNS-1 Servers store it. Usingthe From: field, DDNS-1 Serviers furtherassociate ' 1998121 1@l' with address 'ddns-

2.uch.edu.' DDNS-1 Servers will now forward future Lookup requests for record ' 19981211@1' to DDNS-2:UCH.

DDNS-1 Servers return a SDTP server response to DDNS-2:UCH. The response

indicates successful completion ofthe request ADD for ' 19981211 @ 1' in database 'Medlmages. ' The server response is: SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: ddns-2 uch.edu SUCCEEDED ADD 19981211@1

The DDNS system has now globally registered record '1998121 l@l^τ in the universal database 'Medlmages'. Crucial implications follow from this design (a) A local system creates a global identifier in a fully automatic manner, without any human

intervention whatsoever. (b) This process requires no form of "root registration" for users of equipment.

(c) A user may operate whatever local system is most desirable, without interference from

SDTP/DDNS. 3. Jane returns for a follow-up visit on 22 Dec 1998. A nurse clicks a barcode reader on

Jane's medical card, which concurrently prompts DDNS-2:UCH to do an internal 'Lookup' client query for the number encoded onto her card (' 19981211 @ 1 ') which was encoded during her first

visit on 11 Dec 1998. Since DDNS-2:UCH has the record '19981211@1' it stops searching, and

does not query DDNS-1 Servers. Jane's previous reading of 11 Dec 1998 is automatically recalled onto the screen.

4. The DD' command now saves the 22 Dec 1998 reading, associating it with the 1 1 Dec 1998 reading through the global index (database "key") ' 19981211 @ 1 '. The SDTP interaction looks like: SDTP/0.9 MODIFY Medlmages Convent-Type: application sdtp; transaction- 'modification" From: ddns-2.uch.edu ADD 19981211@1

The attending physician refers Jane to a Networked Specialist Physician, who makes an appointment of 5 Jan 1999.

Crucial implications follow from the client-server interactions up to now:

(a) DDNS-1 Servers store a mapping from record '19981211@1' to DDNS-2:UCH. DDNS- 2UCH has a mapping to whatever internal mechanism the University of Chicago Hospital uses to record its data. (b) DDNS-1 Servers and DDNS-2:UCH only know about one record ('1998121 l@l'),while the University of Chicago Hospital knows about two records. A "one-to-many" relationship is

created. Because only 1 number is stored at the DDNS- 1 Servers level, global system performance is optimized. Only 1 number provides potential access to all of Jane's records at the University

of Chicago Hospital. (c) Routine business at the University of Chicago Hospital remains on site. This reduces

system complexity on the local side, and further optimizes Level- 1 DDNS performance. DDNS

uses global resources only when local resources do not have the needed information.

(d) A user participates in global information sharing without any special interaction besides barcode reading a medical card. Currently, optical readers provide the most robust construction, but any other encoding mechanism could be used. Similarly, rather than affixing a label, the

medical card be given at the end ofthe visit, with the universal identifier indelibly marked on the card.

5. On 5 Jan 1999 Jane arrives for her referral appointment with a Networked Specialist

Physician (NSP) made during her last visit to the University of Chicago Hospital on 22 Dec 1998.

A nurse at the NSP barcode-reads Jane's University of Chicago Hospital medical card

to begin the process. The NSP local machine does an internal client query 'Lookup' for the number encoded onto Jane's card )' 19981211@1'). This record is not found on the local machine, and so the machine sends a client query to DDNS-2:UCH. SDTP/0.9 LOOKUP Medlmages 19981211@1

6. DDNS-2:UCH receives the previous client query and does an internal 'Lookup' for ' 19981211@1', which it finds. Since the search for record ' 19981211@1' is satisfied, DDNS-

2:UCH does not query DDNS-1 Servers. DDNS-2:UCH returns records from 11 Dec 1998 and

22 Dec 1998. Although miles from the University of Chicago Hospital, clicking a barcode reader on

Jane's medical card provides the NSP instant retrieval of previous ECG readings at the

University of Chicago.

7. Although appearing to the SNP in the same moment, the system now ADDs the reading

taken on 5 Jan 1999 to the NSP local syste, associating it with the global index ' 19981211@1'. Since record ' 19981211 @ 1' is stored for the first time on the NSP local machine, the NSP

local machine also attempts to ADD "up" record ' 19981211@1', for global registration in

databas 'Medlmages'. The NSP local system sends this command to it DDNS server, DDNS-

2"UCH: SDTP/0.9 MODIFY Medlmages Convent-Type: application/sdtp; transaction- 'modification" From: specialist.uch.edu ADD 19981211@1

8. DDNS-2:UCH receives the previous client query 'ADD'. Since DDNS-2:UCH has already registered record ' 19981211@1', it now associates the NSP address with record

' 19981211 @ 1', as an address answering questions about global record ' 19981211 @ 1'. DDNS- 2:UCH returns a server response indicating the successful status ofthe client query ADD: SDTP/0.9 MODIFY Medlmages Convent-Type: application/sdtp; transaction- 'modification" From: specialist.uch.edu

ADD 19981211@1

9. On 6 Jun 1999 Jane visits Massachusetts General Hospital (MAG). A nurse barcode reads Jane's University of Chicago medical card, which posts an internal Lookup client query to DDNS-2:MAG, for the original ECG taken on 11 Dec 1998 (in Chicago, affixed to Jane's University of Chicago Hospital card). Not having seen record ' 19981211@1' before, DDNS-2:MAG asks if DDNS-1 Servers

hnow where to find information about this record. DDNS-2:MAG sends this client query

Lookup request to DDNS-1 Servers:

SDTP/0.9 LOOKUP Medlmages 19981211 @ 1

10. DDNS-1 Servers receive DDNS-2:MaG's previous client query Lookup for record

'19981211@1' in global database 'Medlmages'. DDNS-1 Servers do know about record

'19981211@1': that DDNS-2:UCH answers questions about it.

11. DDNS-1 Servers send a server response indicating that DDNS-2:UCH answers queries about record '19981211@1'. The forwarding message sent is: SDTP/0.9 LOOKUP Medlmages Content-Type: application/sdtp; transaction="forwarding" ddns-2.uch.edu

12. DDNS-2:MAG directly connects to DDNS-2:UCH, which queries machine specialist.uch.edu, requesting records related to '19981211@1': SDTP/0.9 LOOKUP Medlmages 19981211@1

DDNS-2:UCH returns records for ECG readings taken on 5 Jan 1999, 22 Dec 1998, and 11 Dec 1998.

Barcode reading Jane's University of Chicago Hospital medical card in Massachusetts

General Hospital instantly retrieves Jane's previous records, displaying the images on the screen within a moment of clicking the barcode reader.

13. Although appearing in the same moment from the nurse's point of view, the system now saves the 6 Jun 1999 reading to the local Massachusetts General Hospital machine. Since DDNS-2:MAG does not have the '11 Dec 1998' reading (globally indexed by

' 19981211 @ 1 '), it adds ' 19981211 @ 1' to its database, associating it with the new reading taken

locally on 6 Jun 1999. Since '19981211@1' is a new record to DDNS-2:MAG, it also attempts

to ADD "up" the record just scanned from Jane's University of Chicago Hospital medical card, '19981211@1'. DDNS-2:MAG sends a client query ADD to DDNS-1 Servers.

SDTP/0.9 MODIFY Medlmges Content-Type: application/sdtp; transaction- 'modification" From: ddns-2.mag.org ADD 19981211@1 14. DDNS-1 Servers receive the previous client query request to ADD record '19981211@1'

to global database 'Medlmages'. Since DDNS-1 Servers already know about record

'19981211@1', DDNS-1 Servers store the address in the From: header (ddns-2.mag.org) as a

location that will answer queries for global record ' 19981211 @ 1'.

Future Lookup requests for record '19981211@1' now will receive forwarding

instructions for both DDNS-2:MAG and DDNS-2:UCH. DDNS-1 Servers now sends a server response indicating status ofthe request:

SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: ddns-2.mag.org

SUCCEEDED ADD 19981211 @1 15. Jane is in a car accident in New York City, and is rushed to a random hospital, where an attendant discovers a University of Chicago Hospital medical card in her purse. Clicking a barcode reader on the card, a DDNS-2 :NYC internal Lookup learns that record

'19981211@1' is unknown. So it sends a client query Lookup request "up", to DDNS-1 Servers.

16. DDNS-L Servers receive a client query Lookup request from DDNS-2:NYC: SDTP/0.9 LOOKUP Medlmages 1998121 1@1 DDNS-l Servers know about record '19981211@1'. and have two forwarding address associations: DDNS-2:MAG and DDNS-2:UCH. 17. DDNS-1 ServersknowthatDDNS-2:UCHandDDNS-2:MAGanswerqueries forrecord

'19981211@1', and return forwarding instructions for these addresses.

SDTP/0.9 LOOKUP Medlmages Content-Type: application/sdtp; transaction- 'forwarding" ddns-2.mag.org ddns-2.uch.edu

18. DDNS-2:NYC directly connects to DDNS-2:MAG and DDNS-2:UCH, querying for

record '1998121 1@1', using the following client query for both addresses:

SDTP/0.9 LOOKUP Medlmages 1998121 1@1

Four records appear on the screen in the emergency room:

6 Jun 1999 DDNS-2:MAG 5 Jan 1999 DDNS-2:UCH 22 Dec 1998 DDNS-2:UCH 11 Dec 1998 DDNS-2:UCH

While the top-level DDNS service (DDNS-1 Servers) only knows about global record '19981211@1', the New York Hospital emergency room now views four records, from three

devices, from two different sites, simply by barcode reading a University of Chicago Hospital medical card.

The physicians need not know from which facilities Jane has records, and yet her

comprehensive ECG records are available instantaneously.

19. Although appearing to the emergency room in the same moment, the system now ADDs the reading taken on 23 Sep 1999 to the local DDNS-2:NYC system, associating it with the global index of '19981211@1'. Since record '19981211(2⁾1' is stored for the first time on the DDNS-2:NYC, DDNS- 2:NYC also attempts to ADD "up" record '19981211@1', for global registration in database

'Medlmages'. 20. DDNS-1 Servers receives the following client query request to ADD record

T9981211@1' to global database 'Medlmages', from DDNS-2:NYC.

SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: ddns-2.nyc.com

ADD 19981211@1

Since DDNS-1 Servers already know about record '19981211@1' (from DDNS-2:MAG

and DDNS-2:UCH), DDNS- 1 Servers add the address in the From: header (ddns-2. nyc.com) to the list of addresses that will answer queries for global record '19981211@1'. DDNS-1 Servers

then sends a server response indicating status of DDNS-2 :NYC's client query ADD request:

SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: ddns-2.nyc.com

SUCCEEDED ADD 19981211 @ 1

Having made this addition, DDNS-1 Servers will answer future Lookup requests for record ' 19981211 @ 1' with forwarding instructions to :

DDNS-2 :NYC DDNS-2:MAG DDNS-2:UCH.

21. While on vacation in the Florida Keys, away from convenient access to a hospital, Jane experiences chest pain. She goes to an Independent Practitioner (IP) on 8 Oct 1999, and presents her University of Chicago Hospital medical card, which the physician barcode reads.

The physician's local machine does an internal client query 'Lookup' for the number encoded onto Jane's University of Chicago card (' 19981211 @ 1'). This record is not found on the local machine, and so the local machine sends a client query to DDNS-2:ISP. SDTP/0.9 LOOKUP Medlmages 19981211@1

22. DDNS-2:ISPreceivesthepreviousclientqueryLookuprequestforrecord '19981211@1'

in global database 'Medlmages'. Not having seen record ' 19981211 @1' before, DDNS-2:ISP

asks if DDNS-1 Servers know where to find information about record '19981211@1'. DDNS-

2:ISP sends this client query Lookup request to DDNS-1 Servers: SDTP/0.9 LOOKUP Medlmages 19981211@1 23. DDNS-1 Servers receive DDNS-2:ISP's previous client query Lookup for record

'19981211@1' in global database 'Medlmages'. DDNS-1 Servers know that these addresses

answer questions about record '19981211@1':

DDNS-2 :NYC DDNS-2:MAG DDNS-2:UCH.

24. DDNS-1 Servers send a server response indicating forwarding addresses that answer queries about global record '19981211@1\ The forwarding message sent is: SDTP/0.9 LOOKUP Medlmages Content-Type: application/sdtp; transaction- 'forwarding" ddns-2.nyc.com ddns-2.mag.org ddns-2.uch.edu 25. DDNS-2:ISP directly connects to DDNS-2:ISP, DDNS-2:MAG, and DDNS2:UCH,

querying for record ' 1998121101', using the following client query for all addresses:

SDTP/o.9 LOOKUP Medlmages 19981211 @ 1

Five records appear on the Local Practitioner's screen: 23 Sep 1999 DDNS-2 :NYC 6 Jun 1999 DDNS-2:MAG 5 Jan 1999 DDNS-2:UCH 22 Dec 1998 DDNS-2:UCH 11 Dec 1998 DDNS-2:UCH

These records represent Jane's cumulative ECG patient history beginning on 11 Dec 1998,

globally indexed to record '19981211@F. Thus, even in a remote area, the Independent

Practitioner has instantaneous access to live records, from four devices, from different sites thou-

sands of miles apart, simply by barcode, reading a University of Chicago Hospital medical card.

26. Although appearing approximately in the same moment as the record retrievals, the

system now saves the 8 Oct 1999 reading to the IP's local system.

Since the local system does not have the '11 Dec 1998' reading (globally indexed by ' 19981211 @ 1 '), it adds ' 1998121 1 @ 1 ' to its database, associating it with the new reading taken

locally on 8 Oct 1999. Since '19981211@1' is a new record to the IP's local system, the local system also

attempts to ADD "up" the record (' 19981211 @ 1') just read from Jane's University of Chicago

Hospital medical card. The IP's local system sends a client query ADD to DDNS-2:ISP.

SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: practitioner.isp.com ADD 19981211@1

27. DDNS-2:ISP receives the previous client query request from the Independent

Practitioner's machine to ADD record '19981211@1' to global database 'Medlmages' . Since DDNS-2:ISP does not know about record '19981211@1' it stores it locally, associating it with the address in the From: header as an address that answers queries for global record '19981211@1'. DDNS-2 :ISP will know in the future to query address practitioner.isp.com

for records related to global record '19981211@1'. DDNS-2:ISP returns a server response

indicating status ofthe client query from the Independent practitioner machine. SDTP/o.9 MODIFY Medlmages Content-Type: application sdtp; transaction- 'modification" From: practitioner.isp.com

SUCCEEDED ADD 19981211@1

Since record '19981211@1^* is new to DDNS-2:ISP, it also passes the client query ADD

"up" to DDNS-1 Servers. DDNS-2:ISP sends the following client query ADD request to DDNS-

1 Servers; SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: ddns-2.isp.net ADD 19981211@1

28. DDNS-1 Servers receive the previous client query request to ADD record '19981211 @V

to global database 'Medlmages', from ddns-2.isp.net. Since DDNS- 1 Servers already know about record ' 19981211 @ 1 ' (from DDNS-2 :NYC,

DDNS-2:MAG and DDNS-2:UCH), DDNS-1 Servers store the address in the From: header ('ddns-2. isp. net), associating it with the other addresses that answer queries for global record

DDNS- 1 Servers return a server response indicating the status ofthe previous client query ADD request from DDNS-2:ISP. SDTP/0.9 MODIFY Medlmages Content-Type: application/sdtp; transaction- 'modification" From: ddns-2.isp.net

SUCCEEDED ADD 19981211 @ 1 Now future Lookup requests for global record ' 19981211 @ 1' will receive forwarding

instructions for:

DDNS-2 :ISP

DDNS-2:NYC

DDNS-2:MAG

DDNS-2 :UCH. Of course, each address answers queries using its own network architecture, storage

procedures, and database policies. SDTP/DDNS provides uniform access to the ECGs stored at

these addresses.

This example illustrates the flexibility and generality of DDNS service for large, distributed

collections of data. In this paradigm, data can reside on different machines and machines that do not know about one another, unlike much traditional design for large database systems.

Databases need not be explicitly linked.

Similarly, in this paradigm, data exists as query relations, dynamically organizing and

relating information at moments of request. Yet record recall is efficient, even across the Internet, providing approximately instantaneous response time.

For clarity and ease of illustration, this example illustrates a "two-level" hierarchy of machines. However, SDTP/DDNS databases can be arbitrarily deep rather than two layers deep.

At any moment, new servers can be added at any level in the hierarchy, providing each orga-

nization with maximal opportunity to optimize its own performance, and to administer its own policies.

The DDNS system is driven by manipulation of names, by design permitting easy

portability of machines within any organization. In this respect a namespace becomes a

global variable to which a machine or machines become attached. Thus, for example, ddns- 2.nyc.com could be a single machine, or a pointer to other machines; and/or the New York Hospital could change the type of machine supporting the ddns-2.nyc.com namespace without interrupting service to its local or global community.

The present invention comprises software on computers and firmware in certain ofthe

medical diagnostic devices. The devices ofthe present invention comprise those medical diagnostic devices known in the art which have the ability to store and output information. The DDNS servers ofthe present invention comprise hardware and software and local storage for storing information comprising indices relating to uses of devices on the network. Any of

a variety of IBM PC and compatibles are suitable to the task ofthe workstations attached to

the medical diagnostic equipment or as DDNS-Level-2 servers. All that is required is that

there be sufficient storage to store the indices noted. The DDNS level-1 servers can also be

IBM PC, Sun workstations or indeed any server capable of storing and retrieving information and communicating that information via modems or otherwise to other servers or

workstations ofthe present invention. Thus the software giving rise to the unique identifiers is stored at the lower levels ofthe system while software for storing, retrieving and associated

indices are typically located at the high levels servers ofthe system.

Further Examples: • On a home computer, Jane clicks a barcode on the last grocery receipt, which reproduces the same order as the week before. Arriving at the grocery store, the order has been charged to her credit card, and is waiting for pick up.

• On a home computer John clicks a barcode reader on an old pair of athletic

shoes. A web page appears on which he is offered a choice to repurchase the same shoes (same brand, size, color, etc.), from the same company. He mouse-clicks on "Accept" and the same credit card is charged that originally

purchased the shoes. The shoes are delivered to his house the next day. One barcode click and one mouse click consummate this interaction.

• A student goes to a book store needing several chapters of various books. He selects a book of interest from the shelves, and using the bookstore's PC

"kiosk", clicks on Chapter 3. A web-page returns instantly, indicating that he may purchase this chapter for $1.83, for which he may use his credit card or pay the cashier. Unknown to the consumer, at the moment of clicking the barcode reader, the

publisher has been consulted and the publisher's royalties and bookstore's profit margins have

been combined in the $1.83 purchase. Each month the publisher sends automatically

generated invoices to bookstores that itemize royalties due. Such a mechanism works just as easily for images in publications, and journal articles, etc., and in libraries and photocopy

shops to enhance copyright protection.

• A car owner brings a car to a garage for a muffler repair. Clicking a barcode

reader, the mechanic learns that the muffler is in warranty. The mechanic

provides better service to the car owner, and receives automatic part

restocking from the manufacturer. The manufacturer not only automatically tracks muffler repairs for a given model, but

also the precise plants from which the failed mufflers come. The manufacturer has an

automatic way to track part life-cycles, manufacturing defects, repair warranties, replacement policies, etc. Yet such data gathering is accomplished in the process of normal automotive repair.

On site, a furnace repairman clicks a barcode reader at a broken furnace part, a

cellular phone calls into a local service provider, which in turn recalls the repair history ofthe

furnace, and the part availability for repair. New parts can be ordered from the portable decoder the repairman brings to on-site jobs. The repair process is streamlined, permitting the repairman to order parts order directly from the manufacturer, while on-site, through an on-site cellular connection to a local

service provider, by passing administrative overhead back at the home office.

Many other such examples apply, such automatic tracing of insurance records by an insurance company; repurchases of home appliances, wood, paints. The entire process is universally and automatically indexed at production or transaction time, supported by this

document's "device-based" approach to universal database construction.

A system and method for establishing and retrieving data based on global indices has

been described. As previously noted, although a medical application has been described, it

will be appreciated by those skilled in the art from reviewing the specification and the examples given that many other embodiments are possible using the system with departing from the scope ofthe invention as disclosed.

Claims

We claim: 1. A Method for Establishing and Retrieving Data Based on Global Indices comprising:

establishing a unique device ID for each of a plurality of data generating devices on a

network; registering the unique device ID of each ofthe plurality of data generating devices on

the network on at least one server connected to the network when the data generating

equipment is first used on the network;

establishing a unique user ID for each user ofthe data generating devices when the

user uses one ofthe plurality of data generating devices for the first time; and

retrieving data generated by the plurality of data generating devices by searching for

instances of the unique user ID.

2. The Method for Establishing and Retrieving Data Based on Global Indices of claim 1

wherein establishing the unique user ID further comprises combining the device ID of the data generating device being used by the user with a date/time stamp ofthe first

use by the user.

3. The Method for Establishing and Retrieving Data Based on Global Indices of claim 2 further comprising storing the unique user ID on a token given to the user.

4. The Method for Establishing and Retrieving Data Based on Global Indices of claim 3

further comprising the user using the token with the unique user ID for all subsequent uses of any of the plurality of data generating devices.

5. The Method for Establishing and Retrieving Data Based on Global Indices of claim 1 wherein the data generated is medical data concerning the user.

6. The Method for Establishing and Retrieving Data Based on Global Indices of claim 1 wherein the data generated is commercial data.

7. A System for Establishing and Retrieving Data Based on Global Indices comprising:

a network; a plurality of servers connected to the network for storing data and responding to

search requests; a plurality of data generating devices connected to the servers, wherein each data

generating device has a unique ID that is registered with at least one server when the data generating device is first used ofthe network; unique user ID generator associated with each data generating device whereby a unique user ID is established by combining the unique device ID with a date time stamp of

when the user first used any of the plurality of data generating devices on the network; and

search logic for searching for instances ofthe unique user ID on any ofthe plurality of

servers.

8. The System for Establishing and Retrieving Data Based on Global Indices of claim 7 wherein the data generating devices are medical data generating devices.

9. The System for Establishing and Retrieving Data Based on Global Indices of claim 7

further comprising tokens generated by each of the plurality of data generating devices on which is stored each unique user ID.

10. The System for Establishing and Retrieving Data Based on Global Indices of claim 7 wherein the data generated is commercial data.

11. The System for Establishing and Retrieving Data Based on Global Indices of claim 9

wherein each ofthe plurality of data generating devices further comprises a token reader for reading the unique user ID stored on the token of a user.

12. The System for Establishing and Retrieving Data Based on Global Indices of claim 7 further comprising data transport logic for transporting data generated from one data generating device to another once the location ofthe data has been determined by the

search logic identifying instances ofthe unique user ID on any ofthe plurality of

servers.

13. A Method for Establishing and Retrieving Data Based on Global Indices comprising: establishing a unique device ID for each of a plurality of data generating devices on a

network;

registering the unique device ID of each of the plurality of data generating devices on

the network on at least one server connected to the network when the data generating equipment is first used on the network;

establishing a unique record ID for each record ofthe data generating devices when

the record is created using one ofthe plurality of data generating devices for the first time; and

retrieving data generated by the plurality of data generating devices by searching for instances ofthe unique record ID.

14. The method for establishing and retrieving data based on global indices of claim 13 wherein the records creating is creating records of parts of an assembly.