# PRE2015 4 Groep3

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## Introduction

### Preface

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 the present times, people are more reliant on medicine than ever. People 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 patient's files are being converted to digital files, yet not everyone is using a standardised format, which means communication can be an issue.

A report that the dutch government has released in 2013 entitled ‘polyfarmacie bij kwetsbare ouderen’[1] 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 under-consumption 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 caregivers (nurses, pharmacists, doctors, etc).

Our focal group consists of seniors who:

• Take multiple medications or have complex medication regimens;
• Have been hospitalised for misuse of medication, or are at a risk of being hospitalised;
• 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 a 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 user. 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 manually or at the pharmacy in the near future. The user should get a warning on the display of the medicine box that for instance the medication in slot 1 is running low and this medication should be restocked. The pharmacist can give him the right medicine to refill his box or can give a kind of cartridge filled with the right medicine for his box. By using chips the box can detect which cartridge is placed in every slot. The pharmacist still gives the user information about his medicine or cartridge and their possible side effects. However these explanations will also be available on the display of the medicine box.

#### Doctor

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

## State of the art

### Introduction

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 when it should be taken on it. There is also a plethora of physical medicine cases with dates on them or the specific day of the week to remind the users of taking their medicine. 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

#### Philips Medido

The Philips Medido, a medication dispensing device.

The Philips Medido[9] is an automatic medication dispenser that reminds users to take their medication with an audio 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 user 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 user 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 user 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 users 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 manual 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 user 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 user will not be able to get their medication unless the dispenser is opened. If the user 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 users 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 users 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 user 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. 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 user in what kind of manner it has to use the medicine e.g. on a empty stomach, before sleep etc,etc.

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 user 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 user 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 user
• 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

## Hardware

### Design requirements

The Electronic Medication Dispenser prototype, presented at the final demonstration.

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 consumption. 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.

The dispension system, utilised by the Smint mints.

These are much cheaper to manufacture and do not require a motor for dispensing. However, this dispensing mechanism is much less reliable. 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. A second dispensing method that was considered, was one similar to the PMDS. This system makes use of pre-loaded single-use cups filled with medication. However, since we wanted the general practitioner to be able to adjust dosage when necessary, this kind of system was not an option for us since the medication is already inside of cups, which makes dosage alteration impossible. A second consideration was the use of an Arduino uno [10] instead of a raspberry pi as microprocessor. However the Arduino is not suited to run a decent looking user interface with a touchscreen. Additionaly, our user interface was a java application and the Arduino cannot run java applications. Another option we had In mind was to solder the used wires connected to the pi directly to the pi, so there was no need to connect wires to a breadboard first. This would be a nice improvement to our design, since this would be a huge space saver. However since the pi and components used weren’t ours to begin with and also due to lack of time, this option was eliminated.

### Mechanism

In order to allow individual medicine dispensing we have designed a helix that is able to store the medication. This helix functions in a similar manner to traditional vending machines. When a product needs to be dispensed, the helix is rotated for one full cycle, after which the product is at the end of the helix and falls into the dispenser tray. The electronic medication dispenser is powered by a continuous rotation motor, where the helix is attached to. We initially planned to have the helix 3D printed, as it would provide us with high accuracy and easy mass production opportunities, although this plan fell through. For the final prototype, we manually made the helix by wrapping a 1.5 mm diameter metal wire around a wooden cylinder. In the end, we experienced that our inconsistencies in producing this hand-made helix caused the distribution to not be reliable enough, which is why this part should be made using very accurate production techniques.

 Isometric view of the helix that individually distributes the medication. At the cylindrical base of the helix, a gap was introduced to allow easy attach- and detachment with the rotation motor. Side view of the helix. As seen in the dimensions, the distance between the peaks of the sine is 10.0 mm, exactly the right size for the medication that we have conducted tests with.
 Isometric view of the helix and the rotational motor. As you can see, the helix was specifically designed to fit on the stock protrusion of the motor. Back view of the helix and the rotational motor. In this picture, the protrusion of the motor can be clearly seen.

### Casing and interior

The medication dispenser is cubically shaped for an optimal interior layout. In this prototype, the casing is manufactured out of 6mm Medium Density Fibreboard. This was done as it is an environmentally friendly material, and it allowed for rapid prototyping. Ideally, the casing of the dispenser would be made out of acrylic, as it has the characteristics and properties that suit the use very well. Acrylic is light-weight, durable, clean and if processed properly, soft to the touch. Finally, acrylic can be flexible, which would allow for easier sealing at the top and an overall higher quality casing.

Inside the casing we have embedded a Raspberry Pi model B 512MB[11]. This microprocessor has the ability to react to both digital and 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 has been discussed in the previous sub chapter. 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. Currently, the Raspberry Pi is powered with a USB cable fed to either a computer or a regular power outlet. However, this could be replaced with a lightweight rechargeable battery pack to improve the portability.

 Isometric view of an early design, done in a computer modeling program. Mechanical drawing of an early design, describing the dimensions.

 Overview of the electronic medication dispenser prototype. Interior view of the inner electronic medication dispenser prototype.

## Software

The display connected to the Raspberry Pi.

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. The raspberry Pi is connected to a display on the medicine box to show the user interface while the doctor's interface is a remote interface.

### Remote interface

This interface is designed to be used by the medical professionals that regulate the user'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 User 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 user's credentials can be edited, should this be necessary. This includes the user's full name, a possible ID associated with the user, 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 user file.

### Medicine box application

This interface is designed to be used by the user. As such, the user input is kept to a minimum, and the box acts autonomously. This interface shows the user the current data present on the box. At the top, the user 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 user 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 user. 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

Users nowadays are generally solely responsible for taking their medicine and finishing treatments. This leads to cases where a user 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 user. Especially when medicine treatment is required over longer time period, or when users should continue taking medicine even if they are no longer sick (think of for instance antibiotics), users are more likely to slack on their medicine intake. By encouraging the user to continue taking their required medicine, we hope to see treatments being more effective.

#### Preventing over-consumption after treatment ends

Since users so often are required to take several kinds of medication simultaneously, it may be difficult for the user to keep track of when to stop taking which medicine. This may result in users 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 user 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 user 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, users 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 user'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 user 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 user in the future.

#### Trade-off in freedom of choice of the user and the good of the user

One thing the user will be affected by is how much control the user itself has over its own medicine intake. Is a response required from the machine or the caretaker when the user doesn't take its pills? Has the user any say in which pills to take? Can the user 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 user and their environment. For example, for a user that needs an extraordinary amount of control to make him/her take their medication and frequently does not want take their pills, no response from the device or an option to skip the medication is an adequate solution. Since the effort required to help this user to take their pills could be used to help multiple other users and thus has an higher increase of overall well being of the user and their environment. The response of the machine should judged separately 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 they are feeling better. Ending a treatment on time prevents unnecessary bacteria resistance against the medicine. A caretaker has also less work since they doesn't have remind the user to take their pills. This lowers medical expenses for society or allows for more money to be spend on 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 users. This in turn should allow both parties to be more time-efficient. By providing a direct connection between users, pharmacists and doctors it is possible to treat the user 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 users 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 user is able to take the pills on their own in a correct way since the box is mainly used to encourage correct medicine usage, not enforce it. Even though some measures have been implemented to ensure the safety of the user, it is ethically unjustified to force people to take their medication if they are capable to make their own decisions. If a user has access to this smart medicine dispenser, the user no longer has to worry about keeping track of their pill intake, wonder whether they have taken their pills or if they have taken the right pills. Since pills are stored inside the medicine box, accidental medicine intake is no longer possible. Because of this it is also no longer possible for others to have access to the medication of the user.

The doctor of the user will be able to see the current prescription of the user. They no longer only have to rely on the possible unreliable information from the user. This way the doctor can accurately evaluate the user's current situation and prescribe the most effective medication. Furthermore the doctor is able to change the prescription of the user remotely and they no longer have to instruct the user or the caregiver about the new prescription. This removes the possibility that someone misunderstands the doctor and uses the medicine in the wrong manner. The medicine dispenser is able to recognize the different types of medications and detect hazardous combinations of medication. If the doctor would prescribe medicine 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 user. In that case they can prescribe it anyway. Otherwise, if the doctor is unaware of the hazards he can choose different medicine for the user.

The pharmacist will restock the device. The device will notify the user that the device stock is running low. The user will the bring the device to the pharmacist for restocking. The pharmacist will access the medicine box to see the current prescription of the user and will fill the device accordingly. The pharmacist will then tell the user 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 user 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 is the caregivers of the users. They won’t directly interact with the device since the users themselves can use the device. However their workflow will change if such a device is introduced. They no longer will have to take care of prescriptions for the user 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 possibly pay for these automatic medicine dispensing systems. These stakeholders are mainly concerned with the cost of the device and the cost of maintenance.

## 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. Click on the image to see a the poster in higher resolution.

In order to get insight on the feasibility of this product we have developed a broad business model that can be seen in the image to the right. In this business model canvas, the main components of our business plan are presented. We have examined the activities and resources needed to make this product function in the medical market.

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

• Installation of the device and usage instructions. If the device is very complicated to use this will result in higher training costs. More 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 to the room. This may result in fewer sales due to a lower acceptance rating amongst users.
• Promotion of the device and selection of the user. The device needs to have be well designed to be easily marketable and to be able to fit in the modern day living room or kitchen. Users should be able to operate the device independently without the need of a caretaker to create a large market for the device. This means people with a physical disability also should be able to use this device in a user friendly way. For example people who are color blind or other visually impaired should also be able to use this device.
• Cost of setting up the medicine regime and adjusting the regime. The software used to check-up upon and change the regime is used by the doctors of the user. These doctors should also be trained to be able to cope with this software in a 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 user in the initial period to see if the user is able to operate the device independently. If the device is very complicated longer check-up periods are needed to see if the user truly can use the device in the correct way. More caretakers 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.
• Possible response of a caretaker if the user doesn't take its pills. If the user isn't very compliant with the medicine regime the system could send out a caretaker to see what the problem is and if the user truly has forgotten to take its pills. If the device often fails to remind the user to take its pills or if these reminders are not obvious enough this result in more caretakers send out to check up upon the users.
• 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 caretakers. The medicine box should be large enough so that this restocking shouldn't happen too frequently. The medicine inside the box also 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 possible caretaker to help the user with its medicine use. The user 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 caretaker. This leads to a higher efficiency of a caretaker.
• Fewer trips of the possible caretaker to the user solely to remind and help the user 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 user or making a meal for the user. The caretaker can plan more caretaker activities at a single time moment, so the caretakers time is used more effectively.
• Greater autonomy of the user. If the user refuses a caretaker and wishes to live completely independently, this device could be a solution for this situation. If the user has a particular complicated medicine regime this device could remind the user to take the medicine at certain time points. This is especially helpful if the user is very forgetful since he/she doesn't have to worry anymore about having taken his/her medicine. This could lead to a higher compliance rating since the user lives more independently and thus has a higher sense of responsibility since they are on their own and not looked after by caretakers.
• 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 user. 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 user itself doesn't have to think about the medicine it has to take in. The medicine box gives the correct medication and the right dosage at the right time. This should lead to less incorrect medicine intake or over-/under-medication which could lead to negative impact on the user 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 adjust dosage without having to make an appointment with the user first, which is a huge time saver. This provides for a higher quality of life for the user since his feedback about the medicine regime can be incorporated in a faster and easier way.

## Discussion

#### Reliability of the device

Dispensing medication raises some issues that have to do with the accuracy and the effective use by the user that should be considered when creating the design. To ensure the health of the user it must be certain that the medications are dispensed correctly with the proper dosage. In addition, it is important to know whether the medication has been taken or not to prevent possible overdose. If medication has not been taken, the number build up over time and if the user receives no notice of this, it may cause an overdose by accident. In order to avoid this it will be advisable to make use of a pressure sensor in future designs in order to observe if medication are in the tray or have been taken.

#### Shelf life of the medication

The box should ensure the quality of the medication inside and will have to take the sustainability of medications into account. To realize this, the box should close in a way prevents the inside to get wet and hot since the medication will spoil if this occurs. If done properly, the medication should be good for at least 8 weeks, which is enough to bridge the period of use until the refill. [12] Shelf life can be generally extended but is also dependent on the type medication. [13]

#### Refilling of the medication box

The medicine dispenser that is envisioned uses multiple helices which have to be filled with the right type of medication, since each type of medication, depending on size, needs a different helix, the refilling has to be done by hand. An effective and accurate way to refill the device is may also be possible in the future, for instance by being able to order fully stocked helices from the pharmacist, containing the right kind of medication. The pharmacist will take care of the medication and can ensure that the right type of medication is placed in the right type of helix. The User only needs to replace these helices when his box is out of medication on a weekly or monthly basis. For the medicine box it is really important to know which medication is in which helix and connected to which engine, without this information the software can't deliver the right type of medication with the proper dosage.

#### Privacy

Since the medicine box is connected to the internet for communication with the user’s general practitioner it is also at risk to be accessed by unauthorized sources. Companies potentially could also be very interested in the medication of the users for targeted advertising. It should be taken with great care that the only the people with the right authority can access these medication boxes like the GP of the user, this could be achieved by a log-in system. Every GP needs to have an account to change medication dosage or duration. This account is then coupled to this person and all its actions can be logged on the medication box. This way accountability can checked for since you can see which account changed what on which device. If something goes wrong you can access the device 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 medication box and the owners of these accounts can see the medical dossier of the user. For this reason the information on the medication box should also be encrypted. Commercial companies or hackers shouldn't have access the user's medication if this is done properly.

## Useful links for our own group

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

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

Software src + dist FINAL (17-6-2016): 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
-test medicine box
Mechanics

Interface


Wiki updates

Week 7
Text here

Week 8
Wiki updates
Buffer week

Week 9
Prepare final presentation