A Wireless Method For Monitoring Medication Compliance

1. A Wireless Method For Monitoring Medication Compliance A thesis by Jeffrey S. Jonas Dr. Manikopoulos, advisor

2. keywords • Telemedicine • Eldercare • RFID • sensor networks • ZigBee

3. Take your medicine! Medication compliance (taking one’s 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

4. There are many pill dispensers to help you remember your meds

5. And some transmit their status But they are very expensive

6. 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

7. The “Baby Monitor” model • Wireless • Low cost • An appliance: little to no user interface • Owner controls the operation and costs

8. 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)

9. Interdisciplinary approach The “value added” to this thesis is the breadth of research and correlation of concerns and requirements to technological solutions.

10. 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.

11. Telemedicine integrates many inputs

12. 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.

13. Drug Counterfeiting

14. Prior Research • “Magic medicine Cabinet” • Kenneth Fishkin’s 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

15. Fishkin Medicine Monitoring Pad

16. 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

17. Prototype #2 The pillbox was modified to detect pills in 3 different ways • Switch • Reflective optical sensor • “electric eye”

18. 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

19. Prototype demonstration

20. Future Enhancements The candy dispenser: • Embed a RKE with strong encryption such as Microchip’s KeeLoq rolling code • Removable tray for cleaning • Compartments for different sized pills

21. 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.

22. 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

23. Enhancements (con’t) • 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.

24. Enhancements (con’t) 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

25. 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.

26. RFID tags can be tiny • Hitachi Mu chip: 2.45 GHz, 128 bit ROM • Implantable RFID: 125 kHz, 54 bit ROM

27. 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.

28. 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.

29. 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

30. 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

31. 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.

32. 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.

33. Thank you! Questions ?