PRE2015 4 Groep3

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Group members

• Maurits Ambags - 0771400
• Wesly Chu - 088994
• Arthur Geel - 0907552
• Jasper Sparla - 0844019
• Twan Weernink - 0851703

Introduction

Preface

Fig X.: A common problem among the elderly: polymedication. Roughly 45% of the Dutch citizens aged 65 or over use five or more different types of medication daily.

In present day, people are more reliant on medicine than ever. Patients are expected to take the right amount of their medicine at the right time, often multiple different ones per day. Each of these activities is a process that can easily go wrong, which has the potential to do some serious damage. As we get older, we generally use multiple medicines at the same time, yet our memory becomes worse. The budget cuts in health care result in doctors and pharmacists having less time for each patient, which means they might not understand exactly what they are taking. With the rush of internet and communication sciences, a lot of the patients files are being converted to digital files, yet not everyone is using a standardized format, which means communication can be an issue.

A report that the dutch government has released in 2013 entitled ‘polyfarmacie bij kwetsbare ouderen’ states that over one million people aged 65 and over take five different types of medication every single day. When we expand our view to those aged 75 and over, we see that 20 percent of those take nine different types of medication every day. When you combine that with the fact that up to 40 percent of the elderly receive insufficient information about their medication, an over- or underconsumption of medicine is the frightening result. Often, the medicine old people take are quite potent, leading to hazardous situations when taken incorrectly.

Finally, when we consider the prevalence of dementia amongst the elderly, of which over thirty percent of the people older than 80 years old suffer, it is clear that there is a need for a tool that helps people with their medication, both for when they need to take their medicine, but also as a safeguard to prevent dangerous combinations.

Project Description

The aim of this project is to design and build a secure medication dispensing system that helps seniors manage their medication regimens. It should not only help remind seniors when medication should be taken, but it should also function as a safeguard by detecting medicinal clashes and by establishing a direct connection between the seniors and the care givers (nurses, pharmacists, doctors, etcetera).

Our focal group of users consists of seniors who:

• Take multiple medications or have complex medication regimens;
• Have been hospitalized for misuse of medication, or are at a risk of being hospitalized;
• Have some form of cognitive impairment;
• Require assistance with medication today.

Scenario

User

Mister Smith is an 82 year old senior citizen living in a guided care home. Because of the budget cuts, the care givers are unable to provide him with all the guidance he needs in his daily life, so sometimes it can take some time before a care giver is able to help him with his complex medication schedule. Some more time passes, and it's one o'clock. Luckily, mister Smith's smart medicine dispenser turns on its alarm; lights start to blink and an audial tone is played which reminds him of the fact that he needs to take his medicine. The brightness of the lights and volume increase over a period of five minutes. Mister Smith walks up to the dispenser and presses the button on the screen which turns of the alarm. As the button is pressed the required medication is released in the proper dosage, and the compartment for the medication is unlocked. Mister Smith can also choose to press the button saying he does not want to take the medicine, if this is done a couple of times the responsible physician is notified and can contact the subject. If the alarm is ignored for 5 minutes, the alarm will stop and repeat itself 30 minutes later. After 60 minutes a caretaker could be notified about the medicine intake if that is configured.

Pharmacist

Restocking of medication happens at the local pharmacy. The subject should get a warning on the display of the medicine box that for instance that the medication in slot 1 is running low and that this medication should be restocked at the pharmacist. The pharmacist can take out a cartridge kind of structure out of the medicine box and is able to scan a chip in the box that lets the pharmacist know what type of medication to put in which slot. The pharmacist stills explains to the patient how it should use the medicine and their possible side-effects. However these explanations will also be available on the display of the medicine box.

Doctor

When the patient makes an appointment with the doctor, the doctor is able to see the current medicine intake of the patient and the compliance with the regime of the patient. If the compliance is low the doctor asks the patient what's wrong with the medicine regime and what should be changed. The doctor is able change the regime remotely from his office so that the patient doesn't have to drag the device with him/her to the doctor's office. This also enables the doctor to incorporate the feedback of the patient directly in the medicine regime without bothering the patient to get a whole new routine for his medicine.

State of the art

Introduction

Fig X.: A simple medication storage box. It consists of different, individually closeable compartments that can be used to store various types of medicine. It is only able to hold solids, such as pressed pills or capsules.

Medicine boxes are not a novel concept. Medicine has been around ever since the ancient ages, and medicine boxes are a logical extension of medication, required to keep things organised. Modern pharmacies often have the medication distributed in individually sealed boxes or bags with the date of when the medicine should be taken on them, and there are also a plethora of physical medicine cases with dates on them to remind the patients of when medicine needs to be taken. Some of the aforementioned medicine cases can be locked to prevent medicine abuse, yet there is no medicine box on the market that functions as a double-check and as an assistant to remind you to take your medication.

Medicine boxes

Medicine boxes or pill organizers are useful tools to both keep your medicine organised, and to help remind the patients of taking them at the right time. Most of the existing medicine boxes have the date and time on them, such as this one-month pill organizer. (http://i.ebayimg.com/00/s/ODM0WDEwMDA=/z/NMcAAOSwHjNWCEgu/$_57.JPG). While a product like this is both useful for organised storage and reminders of when medicine needs to be taken, there are some flaws to it. As the procedure of replenishing the medicine inside has to be done manually, there is a good chance of it going wrong. In most care homes, care givers or house pharmacists are in charge of the replenishing, yet the elderly that still live on their own have to do it themselves. There is no inspection that determines whether medications can be used in addition to eachother, and finally, the medicine can be taken at all times. There is nothing that stops the patients from under- or overconsuming medicine.

Medicine Reminder Applications

Medicine reminder applications can be considered a step up from medicine boxes in terms of technical complexity. These applications function as a digital diary that aids patients in reminding them when medicine should be taken. In the user interface of these applications you can see a schedule of what medicine should be taken by what time, along with some visual information about how it looks, what it does and the instructions for use. A big amount of medicine reminder applications can be downloaded for free for mobile devices. Since our target group are the elderly, mobile devices are often something they do not use, as it can be too complicated or unpractical. However, reminder applications are not limited to mobile phones. A company named e-pill is currently offering a line of physical products that help remind patients of their medicine intake. This line consists of watches and alarm clocks.

Automatic Pill Dispensers

Pill dispensers are more advanced editions of medicine boxes that have the ability to deliver medication at pre-determined times. They can be helpful in regulating medicine intake, for those who either intentionally or unintentionally take more or less medicine than they actually need. With most automatic pill dispensers there is a visual or an audial notification when a pill is dispensed. Pill dispensers can also function as a means of supervision: if a dispensed pill is not taken out of the space, the caregiver or supervisors can be notified, making improper use of medicine very much preventable.

Philips Medicine Dispensing Service (PMDS)

Fig X.: The Philips Medication Dispenser Service, a device that helps patients regulate their medicine intake.

The Philips Medication Dispensing Service is a simple way to manage even the most complex medication regimens. It is designed to help seniors who: - Take multiple medications or have complex medication regimens. - Have or are likely to be hospitalized for misuse of medication. - Have varying degrees of cognitive impairment. - Have limited mobility and are at risk for falls - Require assistance with medication today.

The Philips Medication Dispensing Service is a highly reliable system for dispensing medications accurately and on time. When a simple audio reminder is played, the patient has to push a button to get their medications at the pre-programmed times. This service makes it easy to know what medication to take at what time, if one is struggling to keep track of this by themselves. This system effectively eliminates missing doses, and it gets rid of the struggle some have with pill bottles. If the medication is not taken at the pre-programmed time, the allocated staff at Philips is notified, which enables them to alarm the caregivers.

This product is fairly simple to use for the care takers. All of the medicine is already inside of the machine, and they get a visual and audial notification when it’s time for them to take the medication. The care takers has to press the red button on the front of the display, which dispenses the cup with the medication. An in-depth explanation can be found below.

STEP 1: Load. Caregivers or those close to the care takers put the medications into individual cups and load them into the dispenser. They then provide the medication schedule to Philips who will program the dispenser.

STEP 2: Dispense. When the visual and audial reminder is played, the care taker has to press the red button. The dispenser will dispense the medication you have loaded for the care taker– at the programmed times. It is possible to dispense the medication early, this can be done by interacting with the display.

STEP 3: Alert. The dispenser can be connected to a telephone line. If a dose is missed, the dispenser has the ability to contact allocated people through said telephone line. This way, they can visit the patients to ensure the medication is properly used.

ADVANTAGES: The Philips Medication Dispensing System is a solid foundation for safe medicine use for those who are unable to keep track of it themselves. The interaction with the system is straight-forward, and should be understandable for the majority of the patients. The system has a great way of truly taking care of the patient. If the patient misses out on the medication, the allocated staff at Philips get a notification, which prompts them into contacting the care giver. This way, improper use of medicine is instantly noticed, and can be prevented.

DISADVANTAGES: This machine functions using pre-loaded single-use cups filled with medication. This means that the doses are static, it cannot be changed once the cups have been put in. This machine does not ensure that the patient actually takes the medication. It merely ensures that the patient is given the medication at the pre-programmed times, though the patient could (in)voluntarily skip the medication, even after it has been dispensed. Loading the dispenser is a troublesome task. It is advised that it’s done by the care givers, as senior citizens still living on their own can have a hard time managing it by themselves. Some seniors definitely require a more automated system, which negatively impacts this service as they would also need an additional care taker. The allocated staff at Philips are no pharmaceutical experts. This means that while they do review the medication regimens while pre-programming the service, mistakes that the doctors or pharmacists have made can slip through their supervision. It also means that they do not have the authority to make adjustments to the patients’ medication, if such is needed. Finally, his system is fairly expensive in use. In order to use this service, a monthly fee is to be paid. This monthly fee is priced at $59.95/month, which can be an issue for some senior citizens, as they have a limited pension entitlement, which sometimes is pretty small.

Philips Medido

Fig X.: The Philips Medido, a medication dispensing device.

The Philips Medido is an automatic medication dispenser that reminds patients to take their medication with an audial and visual notification. It can ensure correct medicinal usage by reminding and dispensing medicine at the appropriate times. It is designed for those that use a lot of medicine at specific times, a lot of different times, or for those that have difficulties keeping up with their medication. The interaction is designed to be extremely simple to ensure correct use amongst all people. It can also automatically notify care givers of circumstances when the patient does not take their medication, preventing further occurrences.

Functionality

Just like the Philips Medication Dispensing System, this product is specifically designed to be easy to use. Special ‘medication rolls’ have to be placed in the machine, after which the patient only has to press the ‘OK-button’ at pre-determined times when medication needs to be dispensed.

STEP 1: Get medication. Before it’s able to be used, the Medido has to be filled with the medicine. At pharmacies, it’s possible to have your medication to be packed in so called ‘medication rolls’, a plastic sequence of bags containing your medication for certain times.

STEP 2: Fill. Usually, the Medido is filled when the medication is received at the pharmacy. The bar code on the medication roll is checked to ensure the medication roll belongs to the right person, and the Medido is loaded with the correct medicine.

STEP 3: Dispense. When reading the corresponding bar codes on the medicine rolls, the Medido will prompt the reminder of the medication at the right times. By pressing the ‘OK-button’, the medicine will be dispensed.

STEP 4: Alarm. If the medication is not taken in x minutes, a report will be automatically filed to the care giver. They will be responsible to contact the patient to ensure their well-being. This way, a correct use of medication is ensured.

ADVANTAGES: The Philips Medido is a great device that has the ability to make medicine use for seniors less complicated. The very simple user interface makes it easy for the patients to get their medication at the right time. The dispenser also automatically cuts the medication rolls to allow simple medicine usage. This device has the ability to notify care givers if medication is not taken. Because of this, (un)intentional abuse of medicine can be avoided. Finally, this dispenser can be obtained through the Dutch home care system. If one is legally entitled to help with their medication intake, one can be acquired for free. This makes it a good alternative to the more expensive Philips Medication Dispenser System.

DISADVANTAGES: The Medido can be hard to use, the much-needed instruction manual1 is a testimony of this fact. The main difficulty people seem to have is re-filling the dispenser with the medicine rolls. The manual states that the rolls need to be folded in ±4cm increments, which can be very hard for seniors with decreased hand coordination. Dispensing medicine has the potential to go wrong. If the patient does not understand the interaction properly, they might start pulling the medication rolls when they are dispensed. This can lead to interruptions, which have to manually be fixed. Before the device is fixed, the patient will not be able to get their medication unless the dispenser is opened. If the patient does not have access to the key to open the device, this could mean they miss medication for longer periods of time, which should not be allowed to happen. This machine functions because of the medicine rolls. If these are unavailable, this machine is not able to operate. As said before, it’s hard to re-fill the dispenser with the rolls. It’s possible for the pharmacist to do this, though the dispenser would have to be taken to the pharmacist in this case. Because a lot of seniors are less mobile, this can be a challenge. The medicine rolls also do not allow any flexibility. The medication has to be pre-determined at the pharmacist, so adjusting the medication is not an option. The whole roll needs to be finished before it can be adjusted again.

Conclusion

It's clear that the current options for automatic medicine dispensers have their limitations, and most certainly need some adjustments before they can be seen as a perfect product. A general theme is the lack of communication with the pharmacy or the doctor's office. Most of the reminders work with a pre-programmed schedule, which has to be done by the patients themselves or by doctors/pharmacists/care givers. The current systems can only notify the aforementioned group if the medication is not taken, which is a huge miss. A direct connection between these two groups could mean an innovative new health care system with instantaneous dosage changes, which can cut down on a lot of costs.

The systems of the current generation does not allow flexibility. For the dispense systems to function, the medication has to be prepackaged in plastic bags and thus cannot be adjusted after they have been enclosed. This forms a problem for patients with a dynamic medicine regime whose prescription may change weekly. The date and time for the medicine intake is also fixed which isn't very flexible. The patient may not be able to take its pills at that time or is simply somewhere else where the device isn't available. The device should have the option to change the timetable or delay the medicine intake. We hope to remedy this shortcomings in flexibility of the medicine intake.

Requirements

This medicine box should be able to dispense medicine into a compartment that the user can access whenever the time is right. To do this, the box should keep track of its schedule and dispense medicine when necessary. When medicine is due, the user should be notified by the box that medicine is ready to be taken. The medicine storage consists of several separate containers, not directly accessible by the user. The box should dispense medicine from these containers into the aforementioned compartment, according to its internal scheduler. It should also remind the patient in what kind of manner it has to use the medicine e.g. on a empty stomach, before sleep etc,etc. The patient also should be able to delay the medicine intake by pressing the snooze button if the patient isn't able to take the medicine at that time.

Secondly, the box should be remotely accessible by caretakers and doctors. They should be able to use an application to update the dosage of medicine in the box. This should alleviate some of the confusion for the patient when dosages change, and should prevent over-consumption of medicine, since dosage can be changed without an intermediate appointment with the doctor. It should also be possible for the doctors and caretakers to see the historical medicine intake of the patient and if it is following its prescription.

To refill the box, the user should be able to pick up (parts of) the box, so that it can be taken with them to the doctor and/or pharmacist. We rely on the caretakers' expertise to fill the box and update the data in the application accordingly, so that the user should not have to concern themselves with their medicine intake.

These requirement should lead to

• Prevention of intake of expired medicine
• An increase in the autonomy of the patient
• An increase in compliance with the medicine regime
• A decrease in healthcare costs
• A decrease in incorrect medicine intake
• An increase in the efficiency of the care givers

Design

Design requirements

The design of our medication dispensing system is carefully considered and designed to fit our design requirements. By taking a look at already existing products and services, like the Philips Medido, we were able to gain awareness on how we can make our product stand out in the highly-competitive medical market. In the pictures below is shown how the box will be built, the side-parts are missing here. One of these side parts, namely the compartment where the medication is dropped into, will have a box like shape and is able to be taken out of the box to grab the medication for ingestion. This box will slide through the rails which are visible in the pictures. The drawing at the end gives us the sizes of the internal components, the PI, engine and helix. For the internal design requirements the helix is the most important. This helix will work in a similar way to a vending machine. In our prototype, we will only be making use of one helix. However we envision the future design to incorporate multiple of these helices, to be able to dispense multiple, different types of medication at the same time. The helix shown in the picture below contains a solid end with a small compartment that fits the dimensions of the stepper motor powered by the pi. This way the helix can be easily attached to the motor without the requirement of glue or other attachment methods. The helix can be taken out of the box when its due for restocking of the medicines. A second requirement of the helix, is that the size in between one full rotation of the helix is required to be similar or slightly larger than the type of medication used. If these gaps are too large, the medicine can simple fall out of the helix or get stuck, which is unfeasible. We envision that these helices will be made for each type of medication in the future so that for every type of medication, there is a helix with optimal dimensions to make sure the medicine never gets stuck or falls out of the helix. In an ideal future, these helices can be delivered with the medication already inserted into the gaps of the helix, this way the pharmacist saves a lot of time by not needing to restock the helix pill by pill. Another requirement is that the wires attached to the pi are taped down to the box interior. If wires are not properly taped down, they might get stuck in the helix rotations and cause the entire system to crash. In the future, the pi is ideally replaced with an even smaller processor to save space and to prevent the possibility of wires getting stuck in the helix. By replacement of the pi with a small processor, you also save valuable space, which allows the entire box to be smaller or more streamlined. For exterior requirements, the box obviously needs to look streamlined. A streamlined and aesthetic device makes the user feel more confident in its abilities to dispense the right kind of medication. The device also needs to be able to fit in the interior of a modern day kitchen. Another exterior requirement is the display. The display is the most important functional component of the exterior design. The application that runs on the display needs to be user friendly and easy to manage, so the user can never get confused about the functionalities of each button. More about the application will be explained below. Additional exterior requirements are the signals that appear when medication is due to be taken. These are the possible sound and visual signals, like an alarm or flashing lights and the pop-up on the display interface. Right now our design / prototype only incorporates LEDs and a pop-up on the interface when medicine is due to be taken. Since these signals can be easily overlooked or forgotten, audio signals are a must have requirement for future design.

Considerations

Different kinds of dispensing mechanisms have been discussed before the helix mechanism was chosen. For instance gravity based dispensing mechanisms, like the smint dispensing mechanism, have been considered.

Smint dispension system

These are much cheaper to manufacture and do not require a motor for dispensing. However, this dispensing mechanism is much more unreliable. Sometimes multiple smints (medicines) could come out of the lid at once and sometimes none come out of the lid at all. This is why the helix dispensing system was chosen, since this makes it very unlikely that the wrong dosage is dispensed and we initially wanted to prevent over- or under-medication.

Mechanism

The helix that individually distributes the medication.

The helix that individually distributes the medication.

Casing

The medication dispenser is powered by a Raspberry Pi model B 512MB. . This microprocessor has the ability to react to both digital as analog inputs created by the interaction with the device, which makes it perfect for our prototype. This microprocessor power controls a helix-shaped dispensing tray, which can be seen in Figure X [update needed]. The microprocessor, the motors and the other mechanisms all fit snugly in the dispenser. The dispense chute is moved by the helix-shaped rings. When these are rotated by the engines, medicine will be dispensed.

Side view of an early mockup.

Mechanical drawing of an early mockup.

User interface

Fig X.: The display connected to the Raspberry Pi.

The Raspberry Pi is connected to a (currently unknown) sized display. This screen is mounted on top of the medication dispenser, and is used to provide extra information to the patients about their medicine usage, as well as a way to interact with the product. For example, the display can be used when a patient decides he/she wants to delay their medication by a set amount of time.

Software

Our overall design does not only require a medicine box that can autonomously dispense and schedule, but also a way of remotely accessing this medicine box and changing its settings. This means that our application has two parts: first being the software running on the medicine box, and secondly an interface that allows caretakers and/or doctors to connect to the device.

Remote interface

This interface is designed to be used by the medical professionals that regulate the patient's medicine intake. The doctor or general practitioner would use this interface to edit the schedule and contents of the medicine box. Following this, an apothecary can fill or restock the box according to the data present in the interface. Upon initialisation, the user is expected to connect to the medicine box remotely. This is currently achieved by selecting "Open Patient File" from the File menu at the top, and entering the target's IP address. This interface allows these users to do the following: First, at the top of the interface, the patient's credentials can be edited, should this be necessary. This includes the patient's full name, a possible ID associated with the patient, and their date of birth. The rest of the interface is dedicated to setting data of medicine inside the box. The list on the left displays the current contents of the medicine box. Selecting an entry will automatically update the medicine fields with the data associated with that medicine. The user can now edit fields as they wish, followed by clicking the "Save Changes" button to the bottom left. If the user selects an empty list entry and fills in data, clicking "Save Changes" will enter a new medicine into the list with the specified data. Removing a medicine from the list entirely can be done by selecting this medicine in the list, and then clicking "Clear" in the bottom right corner. If the user clicks "Yes" on the Clear confirmation prompt, this medicine and its associated data is removed from the list.

Remote Interface UI

Per medicine, a total of 12 fields are available for medicine specific data, starting with medicine credentials and dosage (here being dosage per pill). Below that, the frequency of medicine intake can be adjusted to be a number of intakes per day or week. Then, a date can be entered from which the treatment of this medicine starts. Since medicine treatment is generally set to a particular amount of days or weeks, we chose to offer a field for treatment duration, as opposed to entering an end date. This should make entering treatment details easier for the user, as opposed to having to calculate a treatment's end date. Finally, a field is available for the user to submit any extra information pertaining to that medicine. This could be comments about when (not) to intake this medicine, how to intake the medicine, or any other comments from the user.

Once the user has finished editing all the medicine data, they would click the "Sync Data" button to the bottom left. This will tell the application to send the new data back to the medicine box, and override its existing settings. After this, the user is free to close the interface, or open a different patient file.

Medicine box application

This interface is designed to be used by the patient. As such, the user input is kept to a minimum, and the box acts autonomously. This interface shows the patient the current data present on the box. At the top, the patient will see their credentials, as not to confuse medicine boxes if many are present in the same home and/or location. This interface also maintains a clock, for the user's convenience. A pane is present displaying the user IP. This is not important to the user, but may make it easier for the remote interface user to obtain this information (since asking the user to look up their IP address themselves is probably not a good idea) As for the medicine data, a list is present on the left similar to the remote interface. Tapping medicine entries in this list will update the contents of the central pane in the window to reflect important data about the selected medicine. This includes the medicine's credentials, its dosage, treatment start, and of course the additional instructions from the doctor.

Whenever a medicine is due to be taken, a pop-up will appear on the screen, notifying the user that one or multiple medicine are due. Since the user may not be immediately present, this pop-up contains an accept and dismiss button. Only when the user presses the accept button, will medicine be dispensed. Should for any reason the user refuse to take medicine, the dismiss button will discard this dispense event and the box continues on as usual. We have chosen to allow the user to dismiss, since forcing the user to take the medicine unwillingly would only result in this medicine being thrown out anyway. So, to save on waste, we would rather have the patient decline the dispensing.

Medicine Box UI

This application's GUI is rather plain, since we do not expect much input from the user. What is more interesting is what this application does in the background. Behind the GUI, two different processes are also running. One of them is the server; this process handles the remote communication with the other interface. This allows the remote interface to pull data from the box, push new data onto the box, and remotely change the box time (this last one for testing purposes).

The last process is the scheduler. This process constructs a schedule from the medicine data for when to dispense medicine, sends alerts to the GUI whenever such schedule entries elapse, and controls the Raspberry Pi's outputs (the motor controlling the spiral and the LEDs). The schedule that this process adheres to is the following: if a medicine is to be taken once a day, this dispense takes place at 9 AM. For two dispenses a day, these are set to 9 AM and 9 PM. For three a day, this is 9 AM, 3 PM, 9 PM. Finally, four dispenses are set to occur at 9 AM, 1 PM, 5 PM, 9 PM. The scheduler currently does not support more frequent dispenses, or different time scales (such as twice a week).

For each medicine in the list, this scheduler computes the first next time on which this medicine should be dispensed. It will obviously take into account the start and end dates of the treatment, as to not dispense a medicine outside their designated treatment period. For every medicine, only the first next dispense date is stored, as to simplify the schedule. Whenever a dispense date elapses, the user is notified, and the scheduler computes a new next date for the medicine that has just been dispensed. As such, the scheduler will always have an up-to-date list containing the first next dispense date for each medicine. If a change to the medicine list is detected (because the remote interface edited this medicine list), the schedule is cleared and recomputed for this new medicine list.

USE Aspects

User

The main benefit of this technology is that it provides a better structure in the medicine intake of the patient. This should relieve the user of the burden of remembering when to take which medicine, and also notify them to take medicine when the user might otherwise forget. It also functions as a safeguard which is able to detect potential clashes of medication. This should provide the user with several benefits:

More controlled medicine intake

Patients nowadays are generally solely responsible for taking their medicine and finishing treatments. This leads to cases where a patient might forget to take medicine, or even take too much medicine. In the first case, this has a direct negative effect on the effectiveness of the treatment. In the latter case this will probably have a negative effect on the well-being of the patient. Especially when medicine treatment is required over longer time period, or when patients should continue taking medicine even if they are no longer sick (think of for instance antibiotics), patients are more likely to slack on their medicine intake. By encouraging the patient to continue taking their required medicine, we hope to see treatments being more effective.

Preventing over-consumption after treatment ends

Since patients so often are required to take several kinds of medication simultaneously, it may be difficult for the patient to keep track of when to stop taking which medicine. This may result in patients continuing to take medicine even after the intended end of the treatment. Pharmacies nowadays already attempt to prevent over-consumption by only giving exactly as much medicine as is required, though this is not always the case. Also, considering the above, if a patient forgets to take their medicine several times, they assume that they have to finish all of their medicine anyway, resulting in them taking medicine after the end of intended treatment.

More importantly, especially in the case of elderly, some medicine may be given on a recurring schedule until further notice from a doctor and/or caretaker. In these cases, the patient should meet with the doctor once more, at which point the doctor may decide whether to continue using the medicine or not. However in reality, patients may continue taking medicine just because they are in the habit of doing so. This is especially a problem for the elderly, where long-lasting or even continuous treatments are not uncommon. This technology should serve as some kind of threshold for the doctor to consider repeating a prescription, and hopefully cancelling it when possible to prevent unnecessary medicine intake.

Minimising medicine resistance

Over-consumption of medicine also leads to future risks in the form of medicine resistance. In some cases, the patient's body may regard the incoming medicine as being hostile (especially for antibiotics) and the immune system may try to combat the medicine. On the long term, this results in the immune system effectively dispatching of the medicine, and therefore making the patient immune to the medicine's effect. Needless to say, over-consumption of medicine will only speed up this process, and preventing medicine resistance may be beneficial to the patient in the future.

Trade-off in freedom of choice of the patient and the good of the patient

One thing the user will be affected by is how much control the patient itself has over its own medicine intake. Is a response required from the machine or the caretaker when the patient doesn't take its pills. Has the patient any say in taking it owns pills. Can the patient skip the medication for days without any response? According to Kantian ethics all off these things are permissible as long as it results in a higher well being of the patient and its environment. For example a patient that needs an extraordinary amount of control to make him/her take its medication and frequently doesn't want take its pills no response from the device or an option to skip the medication is an adequate solution. Since the effort needed to help this patient to take its pills could be used to help multiple other patients and thus has an higher increase of overall well being of the patient and its environment. The response of the machine should judged separably for each individual case to make the right trade-off.

Society

The medicine box should remind people to finish their prescription and not simply stop when their are feeling better. When they complete their prescription they prevent unnecessary bacteria resistance against the medicine. A caretaker has also less work since he/she doesn't have remind the patient to take his/her pills, This lowers medical expenses for society or frees more money for other purposes, such as critical care activities.

Enterprise

Standardizing the way people take medicine should allow pharmacists and doctors to more effectively prescribe and dispatch medicine to patients. This in turn should allow both parties to be more time-efficient. By providing a direct connection between patients and pharmacists and doctors it is possible to treat the patient more effectively.

It is worth noting that over-consumption of medicine is beneficial to pharmacists and pharmaceutical companies, since it increases their sales. While this technology does not in any way hinder their intended sales, there may be a decrease in sales from these enterprises as a result of less redundant medicine intake.

Stakeholders

Primary stakeholders

The primary stakeholders for this smart medicine box are people who will interact directly with the device. These are the patients who will use the device, the doctors who will give the prescription to the device and the pharmacist who will restock the device.

It is assumed that the patient is able to take the pills on their own in a correct way since the box is mainly used to encourage correct medicine usage, and not enforce it. Even though some measures have been implemented to ensure the safety of the patient, it is ethically unjustified to force people to take their medication if they are capable to make their own decisions. If a patient has access to this smart medicine dispenser, the patient no longer has to worry about their pill intake and wonder whether they have taken their pills and if they have taken the right pills. Since pills are stored inside of the medicine box, accidental medicine intake is no longer possible. Because of this it is no longer possible for others to have access to the medication of the patients. Finally, this medication dispenser will be a safeguard to ensure the safety of the patient.

The doctor of the patient will be able to see the current prescription of the patient. It no longer only have to rely on the possible unreliable information from the patient. This way the doctor can accurately evaluate the patient current situation and prescribe the most effective medication. Furthermore the doctor is able to change the prescription of the patient remotely and he no longer has to instruct the patient or the caregiver about the new prescription. This removes the possibility that someone misunderstands the doctor and uses the medicine in the wrong manner. Because of a smart algorithm, the medicine dispenser is able to recognize the different types of medications and detect hazardous combinations of medication. If the doctor would prescribe medicines that would clash with each other the system would inform the doctor about this. Maybe the doctor is aware of the hazardous combination but deems that it is still worthwhile for the patient. In that case he can prescribe it otherwise when the doctor is unaware of the hazards he can choose different medicine for the patient.

The pharmacist will restock the device. The device will notify the user that the device stock is running low. The patient will the bring the device to the pharmacist for restocking. The pharmacist will access the medicine box to see the current prescription of the patient and will fill the device accordingly. The pharmacist will then tell the patient about any new medicine, their possible side effects and how to use them. The pharmacist will also remove any expired medicine or medicine that aren’t part of the prescription anymore. This way the patient will always have the right medicine stocked inside of the device.

Secondary stakeholders

The secondary stakeholders are people who won't directly interact with the device but will be affected by the device and the use of it. Such a group are the caregiver of the patients. They won’t directly interact with the device since the patient himself can use the device. However their workflow will change is such a device is introduces. They no longer will have to take care of the prescription for the patient and can use their time elsewhere. The logistics of the caregivers will also improve since the moment of medicine consumption often doesn’t coincide with other activities of the caregiver. This will result in a higher productivity per caregiver. Since the productivity rises it may be possible that the demand for caregivers becomes lower and that fewer jobs are available for the caregivers.

Tertiary stakeholders

Tertiary stakeholders will be the companies that are in charge of the production, installation and maintenance of these systems. Insurance companies are an another tertiary stakeholder who will possible pay for these automatic medicine dispensing systems. These stakeholders are mainly concerned with the cost of the device and the cost of maintenance.

Key stakeholders, who might belong to either or neither of the first two groups, are those who can have a positive or negative effect on an effort, or who are important within or to an organization, agency, or institution engaged in an effort. The director of an organization might be an obvious key stakeholder, but so might the line staff – those who work directly with participants – who carry out the work of the effort. If they don’t believe in what they’re doing or don’t do it well, it might as well not have begun. Other examples of key stakeholders might be funders, elected or appointed government officials, heads of businesses, or clergy and other community figures who wield a significant amount of influence.

Business case

A Business Model Canvas of the business case, presented in the text below. In this poster all of the components of the business case are presented systematically. Please click on the file to see a bigger image of said poster.

To see widespread adoption of this device the benefits must outweigh the costs. These costs include

• Installation of the device and instruction in its use. If the device is very complicated to use this will result in higher training costs. More man hours will be needed to explain the use of the device and if the device requires an elaborate set-up the installation costs will rise and more adjustments may be necessary the the room. This may result in an lower acceptance rating among the patient.
• Promotion of the device and selection of the patients. The device needs to designed well enough to be easily marketable and to not stand out in the living room. Enough patients should be able operate the device independently without the need of a caregiver to create a large market for this device. This means people with a physical disability also should be able to use this device in a user friendly way. For example poele who are colourblind or otherwise visually impaired should also be able to use this device.
• Cost of setting up the medicine regime and adjusting the regime. The software to check-up upon and change the regime is used by the doctors of the patient. These doters should also be trained to use this software in correct and efficient way. If the software is very complicated the training costs will rise or the doctors will refuse to use this software.
• Monitoring of the patient in the initial period to see if the patient is able to operate the device independently. If the device is very complicated longer check-up periods are needed to see if the patient truly can use the device in the correct way. More caregivers will also be sent out if the device used incorrectly and the device reports that a medication moment is missed. This all results in more man hours spent because of this device.
• Possible response of a caretaker if the patient doesn't take its pills. If the patient isn't very compliant with the medicine regime the system could send out a caregiver to see what the problem is and if the patient truly has forgotten to take its pills. If the device often falls to remind the patient to take its pills this result in more caretakers sen out to check up upon the patients.
• Restocking of the medicine box. The medicine box shouldn't be too difficult to restock and this procedure must happen reliably by either pharmacist or caregivers. The medicine box should be large enough that this restocking shouldn't happen too frequently. The medicine inside the box shouldn't expire too quickly. This means the inside of the medicine box should be a cool, dry and dark environment.

The benefits of this device are.

• Less time used by the caretaker to help the patient with its medicine use. The patient doesn't have to wait for the caretaker to take its pills. The caretaker can do other work more efficiently because the moment of medicine intake is often fixed to the morning or evening. This often leads that more caretakers are required on these moments while there is less demand for the workers in the afternoon. Other tasks like the household chores are less dependent on the time and can be planned efficiently to fill the roster of a caregiver. This leads to a higher efficiency of a caregiver.
• Fewer trips of the caretaker to the patient solely to remind and help the patient with the medicine intake. This often happens since the moment of medicine intake often doesn't overlap with other care activities like helping to dress the patient or making a meal for the patient. The caretaker can plan more of care moment in a single time spot so the caretakers time is used more effectively.
• Greater autonomy of the patient. If the patient refuses a caretaker and wishes to live completely independently this device could be a solution for this situation. If the patient has a particular complicated medicine regime this device to take the medicine in a timely matter. This especially helpful if the patient is very forgetful since he/she doesn't have to worry anymore if has taken his/her medicine. This could lead to a higher compliance rating since the patient lives more independently and thus has a higher sense of responsibility since they are on their own and not looked after by caregivers.
• Less accidental waste of medicine since they are stored in a central place. There thus less liable to get lost in the home of the patient. This also lead to less accidental medicine intake since children or animals don't find medicine lying around the house. This should lead to fewer hospitalizations for accidental medicine intake.
• Better medicine usage. The patient itself doesn't have to think anymore about the medicine it has to take in. The medicine box gives the correct medicine and the right dosage on the correct time. This should lead to less incorrect medicine intake which could lead to negative impact on the patient or even a trip to the hospital.
• Greater flexibility of the medicine regime since the dosage can be changed every day. This can result in a more effective medicine regime since the doctor can easily experiment with dosage and can the most effective regime faster. This provides for a higher quality of life for the patient since his feedback about the medicine regime can be incorporated in a faster and easier way.

Possible issues --> Future improvements

Reliability of the device

Dispencing medicine brings some issues that should be included in the design, this has to do with the accuracy and the effective use by the patient. To ensure the health of the patient must be sure that the medicines will be dispenced correctly. In addition, it is important to know whether the medicines have been taken or not to prevent overdose. In the case that the medicine have not been taken, the number of medicine will grow over time and the patient may take an overdose by accident. In order to avoid this it will be advisable to make use of a pressure sensor in order to observe if medicine are in the tray or have been taken. If this is not the case a notification will appear and the patient can take his medication or check the box.

Shell life of the medicine

The box should ensure the quality of the medicine inside and will have to take the sustainabbility of medicines into account. To realise this, the box should close in a way that wet and hot air stays outside. For the medicine it will be good to have cartridges that are sealed airtight until it is place in the box, these cartridges will be opened when they're placed inside the box. In this way the medicine should be good for at least 8 weeks if done properly, this is enough to bridge the period of use until the refill. Longer shell life is very probable depending on the medicine and could be extended for each individually medicine.

Refilling of the medicine box

The medicine dispenser uses multiple spirals which has to be filled with the right medicine, because these spirals are working in the box the refilling has to be done by hand. For an effective and accurate way to refill it has to be possible to replace the spirals by some clean and filled spirals, in this way the spirals can be easily replaced and in this way the medicine refilled. By replacing the spirals, also called cartridges, the refilling of medicines can be done in a different place. The ideal situation would be that pharmacists refill the cartridges and deliver them sealed to the patient or nurse. The pharmasict will take care of the medicine and can ensure the quality of the medicine in this way. The patient only needs to replace the cartridges when his box is out of medication, this according to a weekly or monthly therm.

If these cartridges will be sealed and marked with a chip the replacement will expire at best. In this way the quality of the medicine is good and the probability of human error is small. For the box it is really important to know which medicine is in which cartridge and connected to which engine, whithout this information the software can't deliver the right dosage. By using chips the cartridges can be connected to any engine the patient wants and the software directly knows which medicine it has to deal with.

Privacy

Since the box is connected to the internet for communication with the patient’s general practitioner it is also at risk from access from unauthorized sources. Insurance companies could have incentives to know the compliance of the patient with the medicine regime. It could cut-off the insurance if the patience doesn't take his medicine regularly. Companies potentially could also be very interested in the medication of the users for targeted advertising. Great care should be taken that the only the people with the right authority can access these medicine boxes like the GP of the patient, this could be done with an account system. Every person needs to have an account to reconfigure or change the machine. This account is then coupled to this person and all its actions can be logged on the medicine box. This way accountability can checked for since you can see which account did what on the machine. If something goes wrong you can access the machine and see whose account is responsible for the mistake. The owner of this account is then liable for the mistake. The communication of the box with these accounts should also be encrypted so that only the medicine box and the owners of these accounts can see the medical dossier of the user. For this reason the information on the medicine box should also be encrypted. Commercial companies shouldn't have access the user's medication if this is done properly.

Useful links for our own group

Historic Log

Individual work log: https://drive.google.com/open?id=14Ykl9HAKBMtJr3HRHOROLrNeHBLKUgkcpnDh3Kak1tQ)

Pi setup pictures: https://drive.google.com/open?id=0B7f1YJwPHq9xdjBiTHMyby1JSkk

Software src + dist 8-6-2016: https://drive.google.com/folderview?id=0B1oQUCKHpzBfbzY0VmZacGkybzQ&usp=sharing

Planning

Week 1
Brainstorm session on project ideas and directions
Field research

Week 2
Define project direction
Clarify our project goals
Define USE aspects
Literature research
Field research

Week 3
Design sketches
Start up qualitative questionnaires
Start up quantitative questionnaires

Week 4
Develop UI for app
Write code for UI
Start prototyping the final design
Questionnaire Data processing

Week 5
Market comparison:
Mobile reminder applications
Philips MDS
Philips Medido

Week 6
User-test medicine box
Mechanics
User Interface
Wiki updates

Week 7
Text here

Week 8
Wiki updates
Buffer week

Week 9
Prepare final presentation

References

• Expiry Dates for Medication