A Wireless Method For A Wireless Method For Monitoring Medication Monitoring Medication

ComplianceComplianceA thesis byA thesis by

Jeffrey S. JonasJeffrey S. Jonas

Dr. Manikopoulos, advisorDr. Manikopoulos, advisor

keywordskeywords

TelemedicineTelemedicine EldercareEldercare RFIDRFID sensor networkssensor networks ZigBeeZigBee

Take your medicine!Take your medicine!

Medication compliance (taking one’s Medication compliance (taking one’s medicine as prescribed) is a major medicine as prescribed) is a major concern because it is a leading cause of concern because it is a leading cause of preventable hospitalization.preventable hospitalization.

5.5% of hospital admissions can 5.5% of hospital admissions can attributed to drug therapy noncomplianceattributed to drug therapy noncompliance

Outpatient deaths due to medication Outpatient deaths due to medication errors increased by 8.48-fold in the USerrors increased by 8.48-fold in the US

7391 died in 1993 due to medication 7391 died in 1993 due to medication errorserrors

There are many pill There are many pill dispensers to help you dispensers to help you remember your medsremember your meds

And some transmit their And some transmit their statusstatus

But they are very expensiveBut they are very expensive

Scope of projectScope of project

Prototype low cost methods for Prototype low cost methods for remote medication complianceremote medication compliance

Make it modular for allow Make it modular for allow configuration flexibility and cost configuration flexibility and cost controlcontrol

““Play nicely with others” (participate Play nicely with others” (participate in larger monitoring systems)in larger monitoring systems)

Research the responsibilities of data Research the responsibilities of data control once gatheredcontrol once gathered

The “Baby Monitor” The “Baby Monitor” modelmodel

WirelessWireless Low costLow cost An appliance: little to no user An appliance: little to no user

interfaceinterface Owner controls the operation and Owner controls the operation and

costscosts

Information Overload!Information Overload!

Intense activity in related areasIntense activity in related areas advances in low power embedded advances in low power embedded

devices, sensors & cryptographydevices, sensors & cryptography RFID deployment, standardization RFID deployment, standardization

and mandatesand mandates Ubicomp has come of age- wireless Ubicomp has come of age- wireless

networks are ubiquitous (WAN, networks are ubiquitous (WAN, WiFi, PAN)WiFi, PAN)

Interdisciplinary Interdisciplinary approachapproach

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

Integrate new Integrate new technologiestechnologies

Wireless networks are small and Wireless networks are small and easy to integrate, and come in all easy to integrate, and come in all sizes (WAN, PAN)sizes (WAN, PAN)

MEMS enables accurate, continuous MEMS enables accurate, continuous monitoring of things that were monitoring of things that were previously unobservable. Closed previously unobservable. Closed loop control systems can now be loop control systems can now be applied to medicine.applied to medicine.

Telemedicine integrates Telemedicine integrates many inputsmany inputs

RFID buzzRFID buzz

RFID is the "next big thing" for inventory RFID is the "next big thing" for inventory tracking. The pharmaceutical industry tracking. The pharmaceutical industry is exploring RFID to thwart is exploring RFID to thwart counterfeiting, in addition to U.S. counterfeiting, in addition to U.S. government mandates.government mandates.

CVS’ “Jump Start” RFID trial was CVS’ “Jump Start” RFID trial was coordinated with the AUTO-ID Center coordinated with the AUTO-ID Center with HIPAA and privacy concerns from with HIPAA and privacy concerns from the start.the start.

Drug Drug CounterfeitingCounterfeiting

Prior ResearchPrior Research

““Magic medicine Cabinet”Magic medicine Cabinet” Kenneth Fishkin’s work at Intel Kenneth Fishkin’s work at Intel

Research Seattle: exploring Research Seattle: exploring man/machine interface with man/machine interface with UbiComp, RFID (linking physical UbiComp, RFID (linking physical objects to the virtual word), RFID objects to the virtual word), RFID privacy, eldercare, RFID in privacy, eldercare, RFID in healthcare healthcare

Fishkin Medicine Fishkin Medicine Monitoring PadMonitoring Pad

The PrototypesThe Prototypes

Modified Candy DispenserModified Candy Dispenser Uses COTS partsUses COTS parts Transmitters may be similar to Transmitters may be similar to

wireless mice, keyboards, game wireless mice, keyboards, game controllerscontrollers

RKE (Remote Keyless Entry) fobs RKE (Remote Keyless Entry) fobs offer a variety of securityoffer a variety of security

Prototype #2Prototype #2

The pillbox was modified to detect The pillbox was modified to detect pills in 3 different wayspills in 3 different ways

SwitchSwitch Reflective optical sensorReflective optical sensor ““electric eye”electric eye”

2 modes of operation2 modes of operation

The sensors are monitored by a PIC The sensors are monitored by a PIC 18f252 microcontroller.18f252 microcontroller.

Connecting a cellular phone to the Connecting a cellular phone to the RS232 port enables stand-alone RS232 port enables stand-alone operation by transmitting change of operation by transmitting change of container status via SMS (text message)container status via SMS (text message)

A wired or wireless connection to a PC is A wired or wireless connection to a PC is also supported for data collection and also supported for data collection and forwardingforwarding

Prototype demonstrationPrototype demonstration

Future EnhancementsFuture Enhancements

The candy dispenser:The candy dispenser: Embed a RKE with strong encryption Embed a RKE with strong encryption

such as Microchip’s KeeLoq rolling such as Microchip’s KeeLoq rolling codecode

Removable tray for cleaningRemovable tray for cleaning Compartments for different sized Compartments for different sized

pillspills

Future EnhancementsFuture Enhancements

The pillbox:The pillbox: Try other sensors such as pressure, Try other sensors such as pressure,

weight, capacitance to detect pills weight, capacitance to detect pills reliably.reliably.

Use missing pulse detection to Use missing pulse detection to prevent ambient light interferenceprevent ambient light interference

Add tilt, motion, e-field sensors to Add tilt, motion, e-field sensors to report handling and to prevent pill report handling and to prevent pill status errors.status errors.

Future EnhancementsFuture Enhancements

When used with a cellular phoneWhen used with a cellular phone Read the notification number(s) from Read the notification number(s) from

the phone (it was hard-coded in the the phone (it was hard-coded in the prototype).prototype).

Allow multiple numbers for notifying Allow multiple numbers for notifying several caregiversseveral caregivers

Add real time clock for daily Add real time clock for daily summaries instead of real-time event summaries instead of real-time event reportingreporting

Enhancements (con’t)Enhancements (con’t)

Expand the SMS (text messaging) Expand the SMS (text messaging) command processing to a full chat command processing to a full chat script similar to UUCP or modem script similar to UUCP or modem dialers to support other command dialers to support other command sets.sets.

Convert from polling to interrupt Convert from polling to interrupt based I/O with watchdog timer to based I/O with watchdog timer to prevent blocking if communications prevent blocking if communications fail.fail.

Enhancements (con’t)Enhancements (con’t)

When connected to a PC via wireless linkWhen connected to a PC via wireless link Use a secure communications Use a secure communications

protocol for authentication and to protocol for authentication and to prevent injection of false data into the prevent injection of false data into the data collection system.data collection system.

Digitally sign the status so the Digitally sign the status so the archives are nonrepudiable.archives are nonrepudiable.

Recessed buttons for restricted Recessed buttons for restricted activities such as firmware upgradeactivities such as firmware upgrade

Sensor wish-listSensor wish-list

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

RFID tags can be tinyRFID tags can be tiny

Hitachi Mu chip: 2.45 GHz, 128 bit Hitachi Mu chip: 2.45 GHz, 128 bit ROMROM

Implantable RFID: 125 kHz, 54 bit Implantable RFID: 125 kHz, 54 bit ROMROM

How tiny?How tiny?

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

RFID PrivacyRFID Privacy

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

RFID blockingRFID blocking

Temporary or permanent deactivationTemporary or permanent deactivation ““zapper”, removal, sever the antennazapper”, removal, sever the antenna Permanent kill command vs. Permanent kill command vs.

reversible sleep/wake commandsreversible sleep/wake commands RSA block tag: interferes with tree RSA block tag: interferes with tree

walking algorithm: replies to all walking algorithm: replies to all addresses, or just a subtreeaddresses, or just a subtree

RFID GuardianRFID Guardian

ELINT in your pocketELINT in your pocket http://www.rfidguardian.org/http://www.rfidguardian.org/ A mobile battery-powered device A mobile battery-powered device

that offers personal RFIDthat offers personal RFID Auditing Auditing Key management Key management Access control Access control Authentication Authentication

RFID GuardianRFID Guardian

Allows full control of RFID activity Allows full control of RFID activity within your personal spacewithin your personal space

Location aware: different profiles Location aware: different profiles depending on circumstancesdepending on circumstances

Notification of RFID scanningNotification of RFID scanning Audit trail of all activityAudit trail of all activity Allows per-tag access, blocking or proxyAllows per-tag access, blocking or proxy

Empowers total control of all personal Empowers total control of all personal RFID.RFID.

ConclusionsConclusions

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

Thank you!Thank you!

Questions ?Questions ?