With an ageing population in the developed world, the costs of care are ever increasing. Providing solutions to elderly people so they extend the period in which can live an independent life, will increase their enjoyment of life, whilst reducing the ever increasing burden on the world's health care systems.
Over the xmas period my 14 yo son and I took a long bush walk along the south eastern coast of New South Wales and started brain storming ideas for a project we could work on together.
I have for some time, tried to seed the idea that the going to university and getting a job is not the only way through life and that starting your own business is a viable alternative.
The aim therefore of our brain storming session was to identify and develop a project that we could possible turn into a business.
This started a conversation about where the growth markets lay. The burgeoning ageing populations and associated problems soon became a topic of discussion.
I was already aware that there significant issues with medication compliance. As it turns out the issue is far more severe that I had assumed. According to Feinstein AR. 'On white-coat effects and the electronic monitoring of compliance' there are some 125,000 deaths per year and an estimated 183 million unnecessary medical visits occur per year due to non-compliance.
With the ever increasing size of our ageing population and the ongoing increase in life expectancy, this problem will only grow.
There are also specific issues in the ageing population with elderly people that suffer from Dementia, Alzheimer's disease and other disease that impair brain function. This class of people are having to entering care earlier than is otherwise necessary due to their health deteriorating due to non-compliance.
Non-compliance has a number of dimensions, from simply forgetting to take a dose, taking the wrong medication or taking the medication on the wrong schedule. All of these can have significant health consequences. [Source: http://www.acpm.org/?MedAdherTT_ClinRef].
Whilst there are a number of devices in the market that attempt to solve some parts of this problem non of the solves all of the issues and those that solve a reasonable number of the issues tend to become extremely complex to operate (they make setting the clock on your microwave look easy).
With Med Check we are looking to solve all of the core non-compliance issues leveraging some of the advances in technology such as smart phones, ubiquitous (at least in the developed world) internet connectivity and the new field of Internet of Things (IoT).
Specifically Med Check attempts to resolve the following non-compliance causes
- Incorrect dosages
MedCheck is intended to be a first class IoT device. MedCheck will have a single button on the front face of the unit which flashes and buzzes when its time to take your medication. Configuration and management of the device will be from your smart phone and a dedicated website.
MedCheck is directly connected to the Internet and MedCheck's specialised website. The MedCheck unit reports regularly on its status. If the unit goes offline a notification is sent to the appropriate person.
MedCheck is able to download its medication schedule from the MedCheck website as well as reporting on compliance and issuing alerts to appropriate parties if a dosage has been missed.
MedCheck uses NFC to connect to a registered smart phone. A smart phone is used to initiate the initial registration of the device to the MedCheck website as well as configuring the devices WiFi connection.
TODO: should this be blue tooth? Blue Tooth is probably more ubiquitous however I've always found it harder to configure than NFC. I'm also not certain of the limitations of NFC.
The MedCheck device is designed to issue a number of notifications including:
- Simple reminders to the patient
- Non-compliance warnings to a Carer
- Cartridge Exchange reminders
There are obviously some serious privacy concerns here that the project needs to deal with. This becomes particularly significant where an elderly person is transitioning from Self Administration to Carer Administration.
The MedCheck website is also likely to contain sensitive information about what mediations and by implications what medical problems a patient is suffering from.
A patients information may need to be segmented with appropriate access controls based on the role each user takes.
There will also be issues in terms of MedCheck handing over control of the device to a Carer when they take over as Medical Power of Attorney.
The MedCheck unit will be locked to avoid tampering and will be child proof.
An authorised user can simply use their Smart Phone's Near Field Communication (NFC) feature to tap the device to unlock it.
[Do we need a PIN number entered to ensure that children can't just pick up the phone and open the device is is relying on the phones own security code sufficient?]
MedCheck is NOT designed to withstand a significant attempt to obtain access to its content but should be adequate to stop young children or others that should not normally have access to the contents.
MedCheck is designed with removable cartridges, so a Carer can load a cartridge using a Filling Guide whilst offsite and quickly change exchange a cartridge during a visit.
MedCheck is designed to take a variety of different cartridges to cater for different schedules. The standard cartridges allows 14 separate pill chambers to be loaded, with options for tall cartridges (allows for a greater no. of pills per chamber) or cartridges with a greater no. of pill chambers. The design also allows for an future upgrade which will allow for multiple cartridges to be loaded.
A key issues with compliance is the risk of accidental overdosing. Patients may forget to take a dose at the prescribed time then think that they can simply take the dose at a latter time. For some medications this can be lethal.
The Dump Gate allows a schedule to be programmed with limits on the latest time a dose can be taken after the prescribed time. If limit is exceed MedCheck is able to automatically dump the dosage into an internal (secure) tray.
As the dosages are secure they can be easily recycled for later usage (it should be remembered that some of these medications can cost thousands of dollars per month).
Note: there is some risk in the recycling of mediations if the tables are mis-identified. How do we deal with this effectively?
MedCheck is designed to operate in a number of modes of operation.
- Self administration
- Carer based administration.
- Medical practitioner administration
The Self Administration mode is designed for highly reliant individuals that may have a complex dosage regime or are aware that they sometimes forget to take a dosage at the required times.
With self administration they are able to load and exchange cartridges using simple to understand filling guides based on schedules configured via the MedCheck website. We see Self Administrations potentially sharing the MedCheck fill guides and schedules with their medical practitioners to confirm that they have correctly understood the schedule.
For Self Administered users, their phone and the MedCheck unit will both sound a reminder when their tablets are scheduled for consumption.
Carer Administration is where a third party, usually a family member, is involved in assisting with the person's compliance.
The Carer can remotely control and monitor the MedCheck device via the MedCheck website with monitoring and basic administration available from their smart phone.
MedCheck will send a notifications via SMS, Email or Voice (telephone call).
A Carer will receive the following notifications:
- That a dose was not taken within a prescribed period of time
- If the dump gate has operated to discard a late dosage.
- When a cartridge is due to be exchange.
Medical practitioner administration
Medical practitioners such as doctors or pharmacists will be able to access and potentially manage the device.
At a minimum the MedCheck web management site will allow a designated Medical Practitioner to view/review medication schedules and possibly modify those schedules.
It is likely that having a Medical Practitioner review schedules will improve adherence and reduce the chance of under/over doses due to incorrect schedules.