A Wireless Method For Monitoring Medication Compliance

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A Wireless Method For Monitoring Medication
Compliance

• A thesis by
• Jeffrey S. Jonas
• Dr. Manikopoulos, advisor

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keywords

• Telemedicine
• Eldercare
• RFID
• sensor networks
• ZigBee

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Take your medicine!

• Medication compliance (taking ones medicine as
  prescribed) is a major concern because it is a
  leading cause of preventable hospitalization.
• 5.5 of hospital admissions can attributed to
  drug therapy noncompliance
• Outpatient deaths due to medication errors
  increased by 8.48-fold in the US
• 7391 died in 1993 due to medication errors

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There are many pill dispensers to help you
remember your meds
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And some transmit their status

• But they are very expensive

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Scope of project

• Prototype low cost methods for remote medication
  compliance
• Make it modular for allow configuration
  flexibility and cost control
• Play nicely with others (participate in larger
  monitoring systems)
• Research the responsibilities of data control
  once gathered

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The Baby Monitor model

• Wireless
• Low cost
• An appliance little to no user interface
• Owner controls the operation and costs

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Information Overload!

• Intense activity in related areas
• advances in low power embedded devices, sensors
  cryptography
• RFID deployment, standardization and mandates
• Ubicomp has come of age- wireless networks are
  ubiquitous (WAN, WiFi, PAN)

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Interdisciplinary approach

• The value added to this thesis is the breadth
  of research and correlation of concerns and
  requirements to technological solutions.

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Integrate new technologies

• Wireless networks are small and easy to
  integrate, and come in all sizes (WAN, PAN)
• MEMS enables accurate, continuous monitoring of
  things that were previously unobservable. Closed
  loop control systems can now be applied to
  medicine.

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Telemedicine integrates many inputs
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RFID buzz

• RFID is the "next big thing" for inventory
  tracking. The pharmaceutical industry is
  exploring RFID to thwart counterfeiting, in
  addition to U.S. government mandates.
• CVS Jump Start RFID trial was coordinated with
  the AUTO-ID Center with HIPAA and privacy
  concerns from the start.

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Drug Counterfeiting
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Prior Research

• Magic medicine Cabinet
• Kenneth Fishkins work at Intel Research Seattle
  exploring man/machine interface with UbiComp,
  RFID (linking physical objects to the virtual
  word), RFID privacy, eldercare, RFID in
  healthcare

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Fishkin Medicine Monitoring Pad

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The Prototypes

• Modified Candy Dispenser
• Uses COTS parts
• Transmitters may be similar to wireless mice,
  keyboards, game controllers
• RKE (Remote Keyless Entry) fobs offer a variety
  of security

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Prototype 2

• The pillbox was modified to detect pills in 3
  different ways
• Switch
• Reflective optical sensor
• electric eye

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2 modes of operation

• The sensors are monitored by a PIC 18f252
  microcontroller.
• Connecting a cellular phone to the RS232 port
  enables stand-alone operation by transmitting
  change of container status via SMS (text message)
• A wired or wireless connection to a PC is also
  supported for data collection and forwarding

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Prototype demonstration

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Future Enhancements

• The candy dispenser
• Embed a RKE with strong encryption such as
  Microchips KeeLoq rolling code
• Removable tray for cleaning
• Compartments for different sized pills

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Future Enhancements

• The pillbox
• Try other sensors such as pressure, weight,
  capacitance to detect pills reliably.
• Use missing pulse detection to prevent ambient
  light interference
• Add tilt, motion, e-field sensors to report
  handling and to prevent pill status errors.

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Future Enhancements

• When used with a cellular phone
• Read the notification number(s) from the phone
  (it was hard-coded in the prototype).
• Allow multiple numbers for notifying several
  caregivers
• Add real time clock for daily summaries instead
  of real-time event reporting

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Enhancements (cont)

• Expand the SMS (text messaging) command
  processing to a full chat script similar to UUCP
  or modem dialers to support other command sets.
• Convert from polling to interrupt based I/O with
  watchdog timer to prevent blocking if
  communications fail.

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Enhancements (cont)

• When connected to a PC via wireless link
• Use a secure communications protocol for
  authentication and to prevent injection of false
  data into the data collection system.
• Digitally sign the status so the archives are
  nonrepudiable.
• Recessed buttons for restricted activities such
  as firmware upgrade

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Sensor wish-list

• The ideal sensor is one that requires no power to
  sense the activity (container open/close) but
  holds the state until read and electrically
  reset. A latching magnetic reed switch is too
  large for this application. A MEMS bistable
  switch would be ideal if latched by a magnet or
  other external force.

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RFID tags can be tiny

• Hitachi Mu chip 2.45 GHz, 128 bit ROM
• Implantable RFID 125 kHz, 54 bit ROM

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How tiny?

• RFID tags (particularly anti-theft tags) are
  already embedded into devices and containers
  where the customer may not know they exist. They
  have no off switch and are often hard to remove.

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RFID Privacy

• Medical records are confidential. Data generated
  at home is often shared with caregivers and
  doctors thus the need for data assurance. HIPAA
  applies to the data once shared, but the patient
  ought to be empowered to set the sharing policy.

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RFID blocking

• Temporary or permanent deactivation
• zapper, removal, sever the antenna
• Permanent kill command vs. reversible sleep/wake
  commands
• RSA block tag interferes with tree walking
  algorithm replies to all addresses, or just a
  subtree

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RFID Guardian

• ELINT in your pocket
• http//www.rfidguardian.org/
• A mobile battery-powered device that offers
  personal RFID
• Auditing
• Key management
• Access control
• Authentication

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RFID Guardian

• Allows full control of RFID activity within your
  personal space
• Location aware different profiles depending on
  circumstances
• Notification of RFID scanning
• Audit trail of all activity
• Allows per-tag access, blocking or proxy
• Empowers total control of all personal RFID.

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Conclusions

• There are many aspects to medical assistance,
  particularly how to control access and
  dissemination of personal data. Data assurance
  must be designed into the system from inception
  if it is to be trusted and resist attacks. A
  smart pill dispenser is just the tip of the
  iceberg.

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Thank you!

• Questions ?