Dissertation

The mobile technology for Taiwanese elderly living safety and prevent medication error. by Hao Lee

Acknowledgement Firstly, thank Brunel University to provide me learning opportunities, in the last studying process, to sincerely thank Professor Olinkha taking the time to give careful guidance and encouragement let me benefited. During school time, thank each teacher and professor of Integrated Product Design Institute offering the guidance on schoolwork, so that I can successfully completed the relevant credits, let me obtain more knowledge in the learning process. Finally, because of the teacher's approval and assistance enable making this dissertation to be more complete and rigorous.

Abstract With technology upgrading and the elderly population increasing, more and more people focus on the health and life of the elderly. But advanced mobile technology brings people many conveniences but just for the benefit of part of people, in fact there are some people who still cannot benefit from these. Therefore, the purpose of this study is to use design thinking to make mobile technology techniques to assist the elderly in Taiwan. And this study through literature review, questionnaires and interviews with experts summarize problems of Taiwan elderly medication safety and living security. Next step is from the elderly human factors point of view to infer the elderly product design principles. Moreover, to observe Taiwan's elderly medication habits, living environment, and finding out appropriate wearable device technology and suitable medication assistive devices. After the investigating and sorting out the insights to establish the design objectives for the integration of cloud medication record systems and wearable device technology, so that the children can remotetracking the physiological status of their parents through the App of the smart devices. Additionally, to collaborate smart medication assistive device to help the elderly parents medication to improve medication safety, at the same time physiological data can also be uploaded to the medication record system for doctors and pharmacists to make more accurate treatment and medication judgments.

Finally, from the product design perspective to design a complete system and products to assist the Taiwanese elderly prevent medication errors and living safety.

Contents 1. Introduction

1

1.1 Background

2

1.2 Motivation

2

1.3 Key research

3

1.4 Project question

4

1.5 Aim and Objectives

5

2. Literature review

6

2.1 Taiwan elderly

7

2.1.1 Basic data

7

2.1.2 Social issues

9

2.1.3 Digital opportunity

11

2.2 Mobile technology

13

2.3 Electronic Health Record System

16

2.4 Insight

18

2.5 Key finding

20

2.6 Summary

22

3. Research Methodology

25

3.1 Overview

26

3.2 Discovery

26

3.3 Definition

27

3.4 Design & Development

27

3.5 Delivery

28

3.6 Summary

30

4. Primary research 4.1 Expert opinion

31 32

4.1.1 Mobile health and personal information security

33

4.1.2 Cloud medication record and medication safety

35

4.2 Questionnaires

37

4.3 Discussion

39

5. Design & Development

41

5.1 Identify project requirement

42

5.2 Analysis & Survey

44

5.2.1 Human factors involved in design for the elderly

44

5.2.1.1 Vision

45

5.2.1.2 Hearing

47

5.2.1.3 Psychophysics & Memory

49

5.2.1.4 Cognition

51

5.2.1.5 Control & Display

53

5.2.2 Elderly medication habit survey

55

5.2.3 Home-used medication device survey

57

5.2.4 Wearable devices survey

59

5.2.5 Elderly living environment survey

61

5.2.6 Technology timeline

63

5.3 Insight & Objectives

65

5.4 Concepts

69

5.4.1 Concept 1

70

5.4.2 Concept 2

73

5.5 Evaluation

76

5.5.1 Expert opinion

76

5.5.2 Questionnaires

78

5.6 Verification and revision

79

5.7 Summary

82

6. Delivery

85

6.1 3D modeling & Rendering

86

6.2 App design

89

6.3 Scenario

91

6.4 Further development possibilities

95

7. Conclusion

96

8. References

97

9. Appendix

101

1. Introduction

1

1.1 Background According to the definition of the United Nations, an aging society is when more than 7% of the country’s population is 65-year-old. In Taiwan, the elderly population as early as 1993 reached to 7.1%, the statistics in 2014 have come to 11.75%, and Taiwan’s Ministry of Interior (2014) predicts that around 2028 it will reach 22.3%. In addition to that, the Council for Economic Planning and Development forecasts that in 2026, on average, it would take 3.2 working persons who are under 64, to take care of 1 person whose age is above 65 (Taiwan Council for Economic Planning And Development, 2012). As the society becomes more populated with aging citizen, gerontechnology is increasingly becoming an important field of knowledge.

The study further integrates resources, developing technologies, products, and academic research, in the aim of improving the quality of life of older adults (Hsu, 2013). Another thing worth notice is that the elderly often suffer from various diseases, while taking a variety of drugs. Furthermore, along with cognitive decline caused by physiological aging and physiological function deterioration, which leads to the elderly becoming high-risk groups to take drugs. The statistics show the Taiwanese elderly have three worst medical experiences: first is repeated medication occupancy, second one is time-consuming accompany diagnosis and last one is mistreatment of medication, with two of them associated with medication error, this has been a serious issue in an aging society. Hence resulting in medical treatment becoming a heavy burden in Taiwan (FDA, 2012).

1.2 Motivation Aging population has already been a trend in this world in most countries. In recent years, the rapid development of mobile technology, especially smart devices, internet and wireless communications technology. These technologies have significantly changed the way people live. So how to apply these assistive technologies, research and development for the elderly to use these technological products, systems and services, making the physically deteriorating elderly have a comfortable and safe life.

(Taiwan Council for Economic Planning And Development, 2012) On the other hand, today's high-tech era of IT products cannot fit in the elderly population, and still has a lot of problems that need improvements. Therefore, to re-explore how to provide the thoughtful design and improvement to the elderly population in Taiwan is most important, while not only providing their children and families but also health professionals more convenience and more efficient tool for caring elderly, it should be one of the most important strategies to solve the aging society’s life support and health care issues.

2

1.3 Key research Before doing various studies and survey, the key research would be carried out in three directions.

The first point is to explore Taiwan's elderly lifestyle as well as the status of the community, including the elderly population, the level of education and family structure. The other part is looking into the social issues in aging society, for example, health problems, medication status and elderly caring issues. In addition, surveying how the elders use digital products, such as the scale and proportions of product design, ways of holding the products, learning process and using experience.

The second direction is to investigate the effects of the development of digital products for people seeking health services, and what are the trends and development potentials of mobile technology in the health industry in the future.

The third direction is to explore EHR system just implemented in Taiwan, how to improve past health care problems and change the future medical environment and behavior of people's health.

This comprehensive survey of these three directions, which are the basic data of the elderly, mobile technology and EHR system, hopefully can summarize and organize the opportunity to meet the elderly in Taiwan using existing technology to enhance the quality of life.

3

?

1.4 Project question Development of mobile technology and the popularity of digital products improve the quality of human life. Many elder people gradually becomes familiarized with these new technology products, however, due to the elderly's physiological degradation, lack of knowledge, lack of interest or cognitive errors and other reasons, technological products are still not very popular. Therefore, elders are not benefiting from the technological advances of our daily life, as they their lives are not made more convenient.

In general, the majority of digital technology products and user interfaces are all based on general experience with younger users, who have not necessarily considered the suitability of the product for elderly users and ignored older consumers' special needs. On the other hand, although the majority market is great, but in recent years it has gradually saturated. Furthermore, the proportion of the elderly population continues to rise, it is time to concern the elderly.

Technology is not only a cool toy carried by young people, but also more expected to take an improvement of the life quality of elderly. So before doing this study, it should clearly describe a main core question: how do contemporary digital technologies assist Taiwan’s elderly to solve the medical and health issues? How to get a balance with the advanced digital mobile technology and physiological state, cognitive and living environment for the elderly? These are the key elements of this study.

4

1.5 Aim and Objectives The aim of this study is to use mobile technology to assist elderly’s life by solving their health problems, on one hand to come up with the design proposal that allows elderly to use technology without the burden, on the other hand to help avoid the elderly’s negligence of their medication.

The objectives will be the methods of how to achieve the overall aim. In order to accomplish this aim of this study, in the general aspects of these objectives might follow the order of research process.

And the objectives are below.

1. Understanding the problems of Taiwan elderly operating digital products.

2. Exploring their living environment and habits.

3. Generalize the suitable design conditions for Taiwan’s elderly.

4. Develop and evaluate the design responses.

5. Design proposal to meet the needs of the Taiwan elderly.

5

2. Literature review

6

Population

11.75 % over 65 years as a percentage of Taiwan Population

2.1 Taiwan elderly 2.1.1 Basic data The basic data is divided into three parts, the first is the elderly population, and the second is the level of education, and finally the family structure.

Due to rapid social change, rising living standards and improved medical technology in recent years in Taiwan, there’s been a swift increase in the aging population, coupled with the rise in average lifespan. The issues related to aging population has aroused widespread concern and discussion. Data from Taiwan Directorate General of Budget, Accounting and Statistics (DGBAS) reveal that in 2014, the average male lifespan was 76.7 years old, women was 83.2 years old and the total average life expectancy was 79.8 years old. According to the definition proposed by the United Nations for an aging society, the population aged over 65 accounted for more than 7% of the total population is aging society, and more than 14% of it is aged society. While in 1993 in Taiwan reached 7.2% and at the end of May 2014 has reached 11.75%(MOI, 2014). Taiwan's population structure will gradually shift from aging society into an aged society in the next few years. Therefore, it demands more attention on elderly care and related researches.

7

Education

62.14 %

only for primary school education or less (including illiterate)

Family status

68.26 % live with their children

It is noteworthy that in addition to the aging population, the level of education is also worth exploring.

Since the ROC government moved to Taiwan from Mainland China in 1944, the government released "National Schools Act" which requires all the age 6 to 12 children to be subjected to six years national basic education. So Taiwanese who were born before the 1940's generally have low level of education, with only 62.14% graduate from primary school or less, 55 to 64 years old only have primary school level of education or less accounted for 34.43% and the illiterate accounted for 22%. The educational attainment of elderly who live in metropolitan area was higher than rural areas. Compared with the survey in 2005, due to the generations changing, the proportion of elderly population with high educational attainment is increasing (MOI, 2009). But in conclusion, the level of education compared with other age groups still has a great distance. This is because of the later development of education in Taiwan.

Chinese people emphasize the family because of its long cultural tradition; the importance of family in Chinese life is well known. Confucianism stresses the importance of family ethics and concepts of filial piety as the cornerstone to construct the social order, and has deeply affected Chinese people's life view and political philosophy (Liang et al., 1996), whereas the Western society focuses on the family status, the statistic showed that Taiwanese elderly who have children accounted for 97.10%; people with three children accounted for 27.16%, and people with 5 or more children accounted for 27.04%.

The survey states that 37.86% of Taiwan’s elderly population live in three-generation household, 29.83% live in two-generation household, whereas only 0.78% live in four-generation household, elders who live alone or with a spouse accounted for 22.35%, while 68.26% live with their children (MOI, 2009). In summary in Taiwan the majority of children take care of their parents and live together.

8

Elderly medical expenses up to

88.72%

have been diagnosed with one chronic disease

x5

31 %

long-term use five or more drugs

41 % of health care spending

35 % elderly patients experienced adverse drug reactions

2.1.2 Social issues The social issues in this part are looking into health problems, medication status and elderly caring issues in Taiwan’s aging society.

According to Health Promotion Administration, Ministry of Health and Welfare (2007) statistics, there are 88.72% of Taiwan's elderly that have been diagnosed with at least one chronic disease. Department of Health Statistics (1994-2006) show that within the higher ranking causes of death in elderly people in Taiwan, the cause of death related to lifestyle are chronic diseases and ranks as the seventh reason.

National Taiwan University Hospital statistics (2011) show that the elderly who needs care in Taiwan suffer from an average of 2.9 kinds of chronic diseases, 56.6% of them suffer from (Tsia, 2011) three or more chronic diseases and 19.6% of them suffer from five or more chronic diseases. The main treatment methods for the elderly who suffer from chronic or serious diseases were positive seeing the doctor, accounted for 81.28% (MOI, 2009). Additionally, NTU Statistics found that the elderly visit the doctor an average of 32.9 times per year, go to 4.1 different medical institutes and see 7.7 different doctors. Department of Health statistics (2011) the aged 60 or older accounted for 41% of health care costs in whole health care spending, and most of which is spent on drugs. While the elderly with increasing age, leading to a variety of physiological functions degradation and predisposing a variety of chronic diseases. It requires long-term use of multiple drugs, and are very likely to have a severe case of polypharmacy occurring. What's more, due to physiological aging and various health problems

9

84.05 % ideal living with their children and wives

Only

2.6 %

want to live in elder care facilities

caused by the regression of physical and mental functions, so that it prolong drug action and increases the concentration, it's easier to produce adverse reactions of drugs, which is why elders who eat the same drugs have more side effects (Tsia, 2011). On the other hand because the doctors they visit are different may not know each other, not the kind of the prescription given by others, hence the patient does not know how much to eat with other drugs. It leads to increase repeating medication and the risk of drug interactions. According to NTU's statistics (2011), there are 31% of who have care needs elderly long-term use five or more drugs. Multiple medication situations among disabled elderly are even more common, there are 81% of them long-term use five or more drugs, and 38% of them use drugs up to ten or more.

On the other hand to investigate the elderly's expectations of future nursing way is to observe their ideal way of living. The age over 65 ideal living ways for the future is to maintain the existing methods (MOI, 2009). This shows that for the present life patterns already belongs to the ideal way of living without the change in the future. At present, the elderly who only have the spouse or cohabitant hope that they can live with their children in the future for 35.43% (MOI, 2009). So through the investigation, the ideal way of living is "living with children" accounted for 68.49%, followed by "just live with a spouse or cohabitant" for 15.57% (MOI, 2009). For another, only 2.6% of elderly want to live in elderly care facilities, it also shows that the life plan for the elderly of Taiwanese elderly is still primarily familyoriented (MOI, 2009).

10

73.4 %

86.5 %

No usage of the computer

Do not have smart devices

Internet Learn

79.5 %

No experience for using the Internet

86.5 %

Non-Internet users have no desire to learn Internet skills

2.1.3 Digital opportunity To enhance the ability of digital and digital opportunities for elderly people, at first will need to understand the status of the digital divide of Taiwanese elderly, using the appropriate methods to improve the real situation. The main purpose of this research was to investigate the analysis of the elderly in Taiwan digital opportunities, understand their capabilities and usage information. The following is extracted from Taiwan National Development Council: 2013 Personal/ household Digital Opportunity survey report, and I summarize some useful data and information below (National Development Council, 2013).

The nation’s Internet reach rate has come to 76.3% and home networking rate for 85.5% in Taiwan in 2013, and was rank first in Asia. After a cross-analysis of the basic personal data the report shows that level of education and computer network used appear a positive correlation. People's educational attainment is more than college education, who has used the computer as high as 96% of the above, and had used network for 93% or more. Additionally, nation’s educational level is just the primary

11

Top 5 Reasons

for non-Internet users do not use the Internet 51.8% Do not know how to use

23.9% Do not need 22.3% Physiological factors 11.6% No interest 10.0% Illiterate and can't type

school or less, who had used the computer for less than 20%, and the proportion that use the Internet less than 15%.

Observations on the behavior of computer usage amount different generations suggests that, over 97% of Taiwan’s 12 to 39 year-old population, who are “digital natives” use computers and internet, while the percentage of users who are 40 year-old and older, who are “digital immigrants”, decreases as the age increases, the 40-49 year-old group has a 89.1% statistic, and drops sharply to 26.6% for users above the age of 65. Moreover, experience of using Internet also sees a 84.3% reading amongst the 40-49 year-old group, drop to 20.5% in the 65 and above group. From the above-mentioned survey we can find out that there’s a huge digital gap separating older users from those whole are below 60 years of age. There’s no doubt that in recent years, smartphones have become an extremely popular and important gadget, but only 12.1% of the elderly population own a cellphone, not to mention that only 6.8% of them have used internet on a mobile device.

Compare the holds and using situation of smartphone and found that the survey shows that over the age of 40 people may simply considered to have a smart phone is the trend of society, without further to understand the function of their smartphone and the to use the Internet on their smartphone. In order to understand the desire of non-Internet users of Taiwanese elderly to learn the network, the survey show that 86.5 non-Internet users have no desire to learn Internet skills, which the main five reasons are "Do not know how to use" for 51.8%, "Do not need" for 23.9%, "Physiological factors" for 22.3%, "No interest" for 11.6% and last one is "Illiterate and can't type" for 10%.

According to Pew Internet (Smith, 2013) published that the America public Internet Rates in 2012 for elderly was 53.0% and who own a smart device was 18%. And then according to Japan's Ministry of Internal Affairs Communication Using Trends Survey (MOI, 2012), the Internet Rates of 65-69 years old was 62.7%, 70-79 years old was 48.7% and the age over 80 was 25.7%. But the age over 60 Japanese elderly own a smart device accounted for only 5.8%. Compared with Taiwan's study, the proportion of elderly using the Internet in the United States and Japan were significantly higher than Taiwan.

12

30% of patients use computer or mobile device to check for medical or diagnostic information

$ $ $ $ From $7.7 billion to $43 billion The remote / mobile monitoring devices is projected to increase

2.2 Mobile technology Faster communication and better collaboration are both the advantages of mobile technology that has become a daily tool in health care, and physicians do not need to spend too much time looking for medical information, equipment and team members, which makes them possible to have more time to treat their patients. Thanks to advanced development of global networks, through a combination of global networks, even if medical personnel do not have to be on site can remotely help patients make treatment or surgery.

The annual consumer market for remote / mobile monitoring devices is projected to increase in 2011 from $7.7 billion to $ 43 billion (Institute, 2012). And there are 68% of clinic staff who are increasingly using smart phones, tablet and laptops to access patient data in 2012 (Epocrates, 2013). Also, in the United States, 30% of patients use a computer or mobile device to check medical or diagnostic information (Cisco, 2013). Mobile technology contains the following items, Tele-health, Cloud computing, remote monitoring, App-driven diagnostics, and Self-tracking. • Tele-health In the future, 81% of suppliers plan to invest tele-health (Bermudez, 2013). And $17 billion annual cost will be saved and is used in the prevention of readmissions (Andel et al., 2012). • Cloud Computing There are 30% of health care decision makers using cloud applications and services, as well as 40% of health information is stored and protected in the cloud (Imprivata, 2013). Furthermore, 63% of customers are comfortable with storing their medical records on the cloud (Cisco, 2013). • Remote monitoring By 2018, $36 billion will be saved globally by remotely monitoring patients with cardiac and chronic disease (Slabodkin, 2013).

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• App-driven diagnostics By 2017, all of the mobile health market revenue will reach 26 billion, while 50% of smartphone users would have downloaded mobile health applications (Hofstetter, 2014). Survey shows that there are 52% of recent smartphone users who use their phones to collect information about health; secondly, there are over 97,000 mobile apps related to health & fitness on the app store; Thirdly, 93% of doctors believe that mobile health apps can improve the patient's health, and 93% of them found value having a mobile health app connected to Emergency Health (Hofstetter, 2014).

• Self-tracking The proportion of American adults to track health indicators is 69%, while people who are more engaged in their health actually get better health care (Duggan & Fox, 2013). “Healthcare providers and caregivers alike are looking for devices to improve the monitoring of seniors in their own homes,” says Jonathan Collins (2012), principal analyst at ABI Research. This idea can be presented by wearable technology, such as GPS trackers, remote patient monitors, and other wearable devices. These devices are increasingly stored and integrated with mobile wireless devices and cloud-based data, it is faster and more efficient to communicate and monitor than ever before. The elderly care products are wireless gadgets and wearable devices that assist keep your parents safe and healthy (Stevenson, 2014).

In the current mobile technology, part of people have been using mobile device to view their medical information. In the future, more App developers will invest in the healthcare market. And the wearable devices, which become good senior care products, help the elderly to maintain health and safety. In this trend, the future development of mobile technology can be expected.

Tele-health Cloud Computing

Tele-health

81% of providers plan to make future investments

63% of customers

are comfortable with storing their medical records on a cloud 14

EHR

A P P S

App-driven diagnostics

Remote monitoring

By 2017

A P P S A P P S A P P S A P P S

next 5 years

$36 billion

over

97,000 mobile apps

will be saved globally by remotely monitoring patients with cardiac and chronic disease

elate to health & fitness on the app store

Self-tracking Level of Patient Access to Electronic Medical Record (EMR) 31%

84%

Full access 36%

Limited access

65%

14% 27% 4%

No access

2%

Doctor: Should Have

15

37% Patirnts: Should Have

Patirnts: Do Have

patients

pharmacy

doctors

trusted provider

H hospital

2.3 Electronic Health Record System Electronic Health Records (EHR / EMR) is an electronic health information collection system about individual patients or groups, it can be shared in network systems. It is a digital format records and ideally could be shared across different health care institutions (Gunter & Terry, 2005).

The advantages of EHR /EMR system: • Seamlessly coordinate the patients’ care among all the medical professionals and institutions.

• Make medical staffs visits patients’ medical records faster, more correctly and easier to manage.

• Reduce medical waste; lower the cost of medical resource.

Taiwan's current medical system is slightly similar to EHR systems, but the difference between them is that electronic medical history is recorded in the NHI IC card in Taiwan. And this card is an important certificate of current citizens to go to see the doctor; also the chip stores the registry data of the recent medical treatment of user. When people seek medical advice, the physician can read the relevant medical information on the IC card, through the card after the physician certification process, which is stored in the content of the NHI IC card. As physicians get the medication history information on the card, physicians can go through medication records to write out a prescription of the treatment of diseases and appropriate medication. This process should be able to avoid medication

16

The advantages of EHR /EMR system: >Make medical staffs visits patients’ medical records faster, correctly and easy to management. >Reduce medical waste, lower the cost of medical resource.

The majority of physicians reported EHR use: 81%

helped access a patient’s chart remotely alerted physician to a potential medication error alerted physician to critical lab value

64%

!

62%

repeat and interactions, and improve the public medication safety and to decrease the waste of medical resources. However, the current storage space of NHI IC card just only be able to store last six visits of personal medical information. If there were patients with multiple chronic conditions, it may not provide adequate long-term medical and medication information. Thus, the government is in fact providing inadequate medication services to the people, so that limits the development of medication safety. Therefore, with the development of cloud technology matures as well as the ability and capacity of the huge cloud of highly calculated, so the Department of National Health Insurance decided to combine network technologies towards the establishment of a network cloud database development.

The preliminary planning is to select public medication history to be the first object, and to set up the "Cloud medication record" data search system. As if the patients went to the hospital after the physicians obtaining the patients' agreement, it is possible to let physicians log in the VPN system of Department of HNI, which stores the patients' medication record files, to enter into instant online queries. Additionally, in order to protect the patients' privacy, the medical history file cannot be downloaded to the hospital computer. By "Cloud medication record" assisting, the physicians would be able to understand the patients' current and previous medications, and when they write out the new prescription, it can accordingly compare whether repeated use or interaction problems exist with an existing drug. On the other hand, it also can help physicians to actively care for patients and enhance the doctor-patient relationship to each other, while improving safety and quality of medication. Because promoting "Cloud medication record" involves information security and personal data protection, yet it requires more powerful equipment to manage a large amount of information.

So now NHI cooperates with only a few hospitals in Taiwan (Department of NHI, 2013).

17

2.4 Insight After exploring several key researches: basic information about the elderly in Taiwan, the development of mobile technology and electronic medical records, in this section will be summarized and arranged into three insights. And these three insights will be organized into key finding of this study in next part. • High operating technology threshold for Taiwanese elderly Despite the rapid development of today's mobile technology, and the networks coverage and the Internet usage population has all continued to raise, the elderly in Taiwan society are still being excluded from benefiting these mobile technologies. The reason is high operating technology threshold. Since the proportion of elderly people in Taiwan to get higher education is not high, the network utilization is relatively low. In addition, the situation is lack of knowledge and low using experience; thus, asking them to operate such digital products will increase the difficulty of operation. It also makes elderly generally produce significant sense of distance to these digital technology products. Moreover, this sense of distance is also difficult to reduce through the means of encouragement to learn. On the other hand, because the elderly person's physical and psychological function decline gradually, so that they cannot be expected to be the same as the normal young people, and have enough reaction to face drastic changes in technology. It has thus increased their operating technology products barriers. • Parent-child relationship Although highly developed science and technology, the rapid change of economic structure and society, it does not necessarily have a corresponding change in culture and national character. From the above investigation point of view that the composing and members of the current family, there are still vast majority of parents are living with their children, and which parent-child relationship is quite close. This is because deep Chinese family ethics and family relationships are all affected by the restriction of traditional ethics. So, in current Taiwanese society, family remains the best life protection of the elderly. By previous surveys have understood the age of elderly the more older the more easier to produce the expectation of dependence on their children. Additionally, from the parents expect to be cared wishes of view; filial piety ideology is still deeply rooted in the hearts of their children and parents. Due to continued decline in fertility rates, increased elderly population, and especially the increased average life expectancy, it makes the elderly health problems are more to be valued.

Therefore, the responsibility of elderly care of course is placed on their children.

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Do not know how to use No intention to use High operating technology threshold

Physiological degradation

Living together Close relationship with their children Parent-child relationship

Children have responsibility to take care their old parents

Lack of integration Not real-time tracking Closed Medical resources

Unfriendly system to patients

• Closed Medical resources In order to respond to the aging population, the development of health care system in an aging society is very important. Even the medical environment and health care system in Taiwan compared to other countries around the world have been leading, but still have a lot of room for improvement.

However, completed medical treatment should not just only have physician's diagnosis, but also need patient's collaboration. For example, although the currently updated Cloud medication record system has promoted the efficiency of diagnosis and medication accuracy, it only acts on the medical side but ignores patients’ side. The medication status of patients at home will definitely affect the effectiveness of the treatment. So if the medication situation is also considered as a part of the patient's treatment, it should be friendlier in integrating the system with medication process of patients, so as to more effectively improve the quality of medication.

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2.5 Key finding The three summarized insights on previous stage expressed the current status of the digital opportunity and the medical environment for elderly in Taiwan. In this section, design plays a role to solve the whole issues and to make appropriate design proposals. Finally, based on the problems and key solutions to organize these proposals together become an integrated product design and health care service. And this service system will offer an easier and more effective design to improve medication safety for the elderly and elderly care issues in Taiwan.

For high operating technology threshold, the first design proposal is to reduce operating requirements for elderly, which also will be able to reduce the chance of operating errors. The products should as much as possible conform to the mental model of the elderly, and the using condition should not require users to learn how to use. The user interface design should not only be able to meet the physical and psychological degradation of elderly but also let the elderly, who have no digital product using experience and fears technology products, can feel comfortable to use. The second design proposal is that to use wearable device design, its currently function is most designed for the sportsloving people and advocating healthy people to detect individual physiological conditions. Which the advantage is that compared to other smart devices, it is more portable and without the burden to carry; in terms of the operation, it is simpler but have a wireless communication capabilities and power consumption is also very low. Therefore, this device fits the needs of the elderly, easy to carry and can detect and track their physical condition. These two purposes are to reduce the psychological and physiological burden of the elderly.

In addition, with regard to a special parent-child relationship, although most parents and children are living together in Taiwan, but in the weekdays, children are working outside and have no spare time to take care of their parents at home. As the result, in this regard, the design proposal through

20

The interface of device compliance with physiological degradation of elderly Use wearable devices to keep track of the physiological condition of the elderly

Part of operation can be mastered by their children is also convenient for remote monitoring and tracking

Linking to the current Taiwan Medical Records Cloud System, and able to update the current situation and reduce medical errors during the treatment

the App in their children's smartphone device to connect to their parents' wearable device, so their children can remotely monitor and track the physiological status of the parents as well as respond to urgent emergency situations. Its advantage are to make it easier for their children to participate in the parents' health, and also to avoid the need for their parents to personally operate interface and allow their children to go to work without interruption. This proposal can reduce their children's psychological burden.

The final design proposal is to improve the closed health care system, make the cloud medication record system link to patient side. Patients can upload the latest physiological state to the system, so that the data could be used as a reference to assist the doctors in making more accurate medical diagnosis. And to collocate with cloud medication record system, it can inform the users to take the medication at the right time or in the right physiological conditions, to reduce the chance of medication errors and repeated medication. The system integration can reduce the medical burden of government.

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2.6 Summary This chapter collected domestic and foreign literature, and these are based on describing Taiwanese elderly to face to Digital Opportunity and medical environments. The aim is that before designing a product, firstly according to the characteristics of the user groups doing the analysis, and then exploring their corresponding and surrounding environment and technology. Which summarizes the appropriate design proposal for the target user, and defines the clear design direction.

From the above literature review can be known, although Taiwanese elderly's acceptability and usage of digital product are low, they have a close parent-child family relationship. Therefore, through the involvement and participation of their children, mobile technology still cannot be hampered for the elderly to use and make the elderly benefit from the advantages brought by advanced technology.

In spite of Cloud medication record system’s addition to providing excellent medical care, it still has room to improve. If the system can integrate the mobile technology, it can effectively increase the treatment efficiency, and better ameliorate the overall health care environment.

To sum up, integrating existing resources and wearable device design is possible to achieve the improvement of medication error for the elderly and elderly care issues in Taiwan. And the summary of these design proposals are integrated into a system blueprint below.

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Indicate

Track

+

Emergency

Upload

It is divided into the following four main functions: • Track The wearable device can detect user’s physiological state, and the patient does not need to learn how to intentionally use or operate, just feel free to wear on the user's body and finally children can replace them to track their parents' immediate physiological state through smartphone APP. It may include physiological state of the user's daily routine, heartbeat, blood sugar, sleep state etc.

• Upload and Share The device can record the user's physiological state and upload them to the Cloud medication record system, moreover allows medical staff in the conditional eligibility can read these personal physiological information, the purpose is to help them to make more accurate medical diagnosis.

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H Share

Taiwan Cloud Medication Record System (EHR)

H H

• Indicate Another feature of the device is the function that to indicate medication. It links to the Cloud medication record system, and can inform the users to take the medication at the right time or in the right physiological conditions, to reduce the chance of medication errors and repeated medication. • Emergency The last one is emergency system in this device, if their parents face unexpected accidents in the home or outside, it can send a signal to their children's smart phone, so that they can monitor at any time and have real-time response.

The above conclusion of this chapter will guide the design towards a more definite direction. Next step is to deeply explore from the view of product design, and according to the above system functions to identify the most appropriate design solution.

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3. Research Methodology

25

3.1 Overview The methodology of this study is mainly based on 5Ds design process and the development track of double diamonds, and cooperating to the development of this study topic and the key summary to make some amendments and adjustments to consistent with main dissertation. Additionally, design is a method to solve the any kind of problem, and requires defining the problem at the beginning.

And then development begins in the design process is not only the horizontal linear sequence which start at input and terminate in output, of course, it but also emphasizes vertical depth exploration.

In addition, the difference between science and design is that science emphasizes the evidence and facts, but it hinders the development of a creative subject; on the contrary, design is considered about the highly sensitive gaze of the surroundings and is relied on researchers to judge a wide range of value. It might be able to because of the different researchers and provoke a different spark to create a different outcome. It's 5Ds design process is a method can be applied to any design problems or challenges not only for designer, and they are Discovery, Definition, Design, Development and Delivery respectively. The following detailed descriptions are each step of design process in this study.

3.2 Discovery At the beginning of the research, discovery is the first procedure of the design process. In this program, first step is to observe recent social state and to explore people, event, things around the community that issues are worth we considered about. Next step is to brainstorm: List all the found information, discuss and expand those interested topics or issues and create a project space. Next is through the mind mapping to find out the relationship and begin collating information, related news and information to narrow down to a specific field, thereby start to identify potential topics and key projects. Finally, to organize the range of research from the identified main themes will be to proceed to the next stage literature review, which includes collecting basic data of the elderly in Taiwan, digital opportunity, health care environment, and other related documents. These literature data are provided from the credible statistical authorities and the government department, which makes the background and motivation of this study start from a more objective point of view, so that it enable the study in a later period can have a more reliable development. This program which applied observation, visualization, brainstorm, secondary research, and the purpose of these steps is to divergent thinking, increase the range of ideas and create a more distinctive projects.

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3.3 Definition The second design process of this study is definition. At first, analyzing and classifying the collected literatures through individual researchers' vision summarize these objective facts and find some interesting relationships, and those results that are insight of this research. Because of these results will be collated by researchers' different point of view, the originality of these resulting insights will be absolutely different with others. Since, the exploring path in the design process is extremely wide, everyone starts toward different direction forward. In the next step, design played a role to propose the design proposals to respond each respective insight, which are key findings. What's more is integrating these design proposals to unambiguous definition of a specific design opportunity.

However, these subjective judgments and design definition has not assessed by public and experts, so the final step in this procedure is questionnaire survey and expert opinion. The main purpose is to investigate this design idea whether meets the target group's expectations or not and ensures the possibility of the implementation in real community. Finally, the design proposal would refer to the survey results and experts opinion, and then adjusting the correcting into the final design definition.

3.4 Design & Development When the program turning to the Design & Development that means it is entering into the second diamond of the design process, which also represents that research and development at this time getting into the second idea-expanding period. First have sorted out the identified project requirement during this design stage, which is Design brief. The next step is that directed at the

27

design brief to use a basic "discovery" tool to propose 6Ws which are who, why, what, how, where and when, and entering into the second research again. And these identified projects requirement are the items need to analyze and investigate, which includes the who need to be concerned about the human factor in the product design process, why the user have such these medication habits, what kind of home-used medication device serve in the recent market, where is the user's living environment, how to use wearable device to perform on the user, and when do these technologies may be actually applied. Survey these information may benefit to clarify the design conditions used on the elderly. The next step is to summarize some insights and set some design objectives from this information, which is to make the later design process have more logic and clearer direction to follow.

In addition, this program is quite important and is the essence of the design process, which needs deeply thinking and judgment. Moreover, these are thought out design objectives would be useful materials to compose the design concept. Next, the designers use professional sketch skills and Image expression to communicate the design concept as an image as the way to the public. However, these ideas still have need objective confirmation, such as expert interviews and public polls. Finally, after some adjustment and modification, the prototype of design consequently produces.

3.5 Delivery The final design stage is delivery, as the name suggests that it is the last one program will convey out the complete design to users. First step is that use 3D modeling computer-aided design software to make 2D drawing convert to 3D model, which benefit is to allow designers to use a more comprehensive perspective to view the entire product. Additionally, using rendering software to simulate the real product material, detail and appearance. A configuration of well-rendered image is combined by the excellent light settings, perfect composition and appropriate scene, and this image can be used as a method to communicate by designers to users. On the other hand, the App user interface design of this system is a part this service, although do not display the real application in this study, the study still uses the diagram of visualization to show the main system framework and functionality. The next step is a scenario that is a detailed record the case of a user interacts with the product or service in a period, so that users can understand the interaction between users with their products or services through the context of the content. The final step is to concern about the product's future development possibilities, from manufacturing to market.

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Discovery

Definition

Observe the recent status

Analysis & Insights

Discussion / Expand the interested topic or issues

Summarize and integrate the Key finding

Organise information / News / Datas narrow down to the several specific areas

Define the appropriate design solution

Literature review / News

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Expert opinion & Questionnaire

Design & Development

Delivery

Identify project requirement

3D modeling App - User Interface

Analyze and survey / Human factor involved in design

Scenario / Persona

Propose design concepts

Further development possibilities

Evaluation / Verification and revision

3.6 Summary In order to review against objectives, understand the demonstration and conform this topic, each step of this design process are unique and carry out their duties in this dissertation structure. As a result, summing up the above design process and the step of the deduction, such a complete design proposal been constructed up. In the final study is that have to provide the conclusions and recommendations, which are the ultimate contribution of this dissertation, in other words, the most important thing is how to use these design advice to change the lives of the elderly in Taiwan and improve future health care services in Taiwan. Furthermore, provide other new design opportunities of mobile technology to benefit more people, and investigate the recommendations of this dissertation whether also be applied to other countries in the world.

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4. Primary research

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Q&A 4.1 Expert opinion This research involves a lot of fields, including science and technology, personal data security and medical services systems. In order to make this research more practical and realistic; therefore, it must interview some experts in various area, and through their expertise analysis and experience sharing to fill the deficiencies of this study. And because the current design proposal involves the sharing of personal information and integration of cloud medication record system, so in this part invited two experts to interview, especially for mobile health and personal information security as well as cloud medication record and medication safety these two parts to access. The following are two separate interviewed content and experts’ introduction.

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Chen, You-Huan University of Pennsylvania LLM & LLCM MarkLaw Law Firm Lawyer http://www.marklaw.url.tw Email:marklawchen@gmail.com

4.1.1 Mobile health and personal information security Lawyer You-Huan Chen graduated from Faculty of Law of National Taiwan University in 1996 and in the same year passed Taiwan lawyers entrance examination, and after graduating from National Taiwan University Law Research Institute later worked in international trade law firm, during which went to the United States studying at the Pennsylvania University and received a master's degree in law. His research interests and areas of practice include commercial contracts disputes resolving, intellectual property rights, privacy information protection, labor law, companies and securities law as well as civil and criminal litigation, related writings have been published in the Decree Monthly, Monthly Accounting Research, Journal of Economic Prospects and other publications (MARKLAW, 2014).

Mr. Chen has an article on the Internet about the medical personal information and mobile health, and the article mentioned how the wearable mobile health technology, affecting medical personal information safety management issues (Chen, 2014). Therefore, this study has some questions about using and sharing personal physiological information. Hopes that through lawyer Chen's professional advice and discussion be able to help correct this system design and allow the system to reach optimal and complete effect.

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Q1: The first feature in this device is that the children through APP can track or query their parents' physiological data by wearable devices, the question is that such this function whether violate any law related a privacy information security (provisions only could be first-degree relatives in a relationship or what kind of relationship is permitted), or what scope or range (physiological information) are allowed?

A1: It seems to be no legal limit on the relatives’ scope of a privacy information protection.

Additionally, collection and utilization of privacy information needs the principle of consent by the individual, and therefore the design of APP has to create a personal consent mechanism. However, in accordance with regulations, medical, genetic, health checks and other more personal information belonging to a special sensitivity (others include sexual life, criminal record), in principle, to collect, process or use, unless based on the following four exceptions: 1. Law expressly provides. 2. Official duties or non-official organ statutory functions necessary to fulfill legal obligations and maintain appropriate security measures. 3. Parties themselves announce in public or other personal information has legitimately announced in public. 4. Public authorities or academic research institutions are based on medical, health or prevention of crime for the purpose as well as for necessity of statistical or academic research, and it is collecting, processing or usage of personal information through certain procedures. However, if under the law to inform and obtain the consent of the parties, whether or not to allow others to collect, process or use special personal information? This is a matter of opinion.

After all, the parties should have their personal information of special autonomy decisions such as overly restrictive, fear hinder the flow of personal medical information, also hinder the development of action in the health industry.

Q2: The assumptive system is that the user can use the Internet anytime, anywhere to upload the latest physiological data to the cloud medication record system, but medical units and medical personnel only when user using medical insurance card be allowed to enter the system to access users' physiological data, if there is such a rule specification to achieve the minimum standards of personal data security, or must have what the premise is consistent with the law?

A2: The medical records, which minimum standards shall be personally agreed, the rest please refer to the foregoing.

Q3: This device can connect to the Cloud medication record system, and according to the patients' prescription and medicine to inform the users take the medication at the right time or in the right physiological conditions, this feature whether violate personal data security?

A3: The medical records, which minimum standards shall be personally agreed, the rest please refer to the foregoing. Even if the current provisions of the Personal Data Act in Taiwan are too strict and unrealistic, but the case of the practical operation, the collection and usage of personal data should be based on Individual acceptance as the basic requirements.

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Tarn, Yen-Huei University of Arizona pharmacy administration PhD Center for Pharmaceutical Care Development, Taiwan Pharmacist Association Executive Director Email:yhtarn@gmail.com

4.1.2 Cloud medication record and medication safety Tony, Yen-Huei Tarn, MS., PhD. graduated from the University of Arizona pharmacy administration and behavioral sciences PhD in 1993, and currently works in the Executive Director, Center for Pharmaceutical Care Development, Taiwan Pharmacist Association and serves as Board of Directors, International Society for Pharmacoeconomics and Outcomes Research, ISPOR, and he had been in Taiwan Society for Pharmacoeconomics and Outcome Research serving as managing director, and in the Department of Pharmacy, School of Pharmacy, Taipei Medical University, served as Head of the Department (NDMC, 2014). Dr. Tarn is a very important and prominent figures, which occupies a pivotal position in Taiwan medication profession, also he had published many books and journal articles about the pharmaceutically.

Dr. Tarn has expressed support for Taiwan's Cloud medication record system in the article (Tsai, 2013); in fact, he is also a member of the plan assessment of the Department of National Health Insurance.

He effort to support the implementation of cloud medication record system that physicians and pharmacists can work together to create opportunities to care for medication safety of patient, and expects to develop other function of cloud medication record system enables play a greater efficiency.

The following question is to draw on his professional in this field to ask him the future development possibility of this study and what the problem may be encountered.

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Q1: This system combines mobile technology device and cloud medication record system, the elderly wears wearable devices, which can monitor the physiological state of user’s body and linked with their children's APP. Ultimately, these physiological data can be tracked by their children and uploaded to the cloud medication record system and share in various medical institutions. The feature of this device is an indication function, it uses the most simple way to instruct the user take the right medication at the right time or in the right physiological conditions, in order to reduce medication errors and opportunities of repeat medication. However, such a system structure maybe need to modify the prescription type and drug packaging to meet the operational mode of this device, Does it help to improve the situation, or do you know any better or easier way may be achieved by existing institutional?

A1: In Taiwan there have private companies already cooperate with the health care system, using bracelets to measure physiological values for elderly people living alone and then transferred to a system for the record. When the elderly appear inappropriate physiological values will summon medical personnel to the home service. However, due to the limited number of patients to participate, the cost is too high, it seems not common. But technically has no problem. Only those systems have not yet combined with cloud medication record system. From the pharmacist's perspective, the biggest problem of this system is no way of knowing what medicine has patients taken at home.

Because medication record system can only record the physician's prescription drug information, but do not have any information about patients in private buy non-prescription drugs or health food.

Unless pharmacists do home care to integrate medication, otherwise patient medication information is neither complete nor truly protect their medication safety. And it's all about the huge budget.

However, if these pharmacist services and technology can be combined with the new payment system in the future, the possibility of the implementation can be improved a lot. In addition, we are working to introduce seven pharmacists kit packaging services, ready to provide this service for people in long-term care institutions, the kit has an alarm reminder function to remind patient to take the right medicine in the opened case. You can use as reference.

Q2: And the another feature can record the user's physiological state and upload them to the Cloud medication record system, moreover allows medical staff in the conditional eligibility can read these personal physiological information, the purpose is to help them to make more accurate medical diagnosis. Does this function indeed to assist medical staff to diagnose?

A2: It's really great help. We do pharmacy home care must track whether the patient disease has control properly, but the lack of data to reflect this situation. If these technologies help provide physiological values to reflect whether the disease has reached the control range, it will be meaningful for caring chronic conditions.

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Have you worried about your family's health?

Age 55~64 (22%)

no (12%)

over 65 (7%) 45~54 (43%)

yes (88%) under 34 (16%) 35~44 (11%)

Do you or your parents have chronic disease?

Family size

no (21%)

over 5 (26%)

not sure (5%)

1 (3%) 3~5 (59%)

2 (12%)

yes (74%)

4.2 Questionnaires The design proposal of this study is that the results are rigorously summed up by a lot of literature and various survey data, and then the inference of the program is both logical and all based on the data. But this is only a subjective judgment; it is lack of more objective verification. So the purpose of this questionnaire is that through a few questions and a brief description to introduce them this design system structure and functionality and to conduct an investigation. Collect their opinions and preferences from this program, and analyze the results with the data, thereby reaching revision and confirmation of the design proposal by public. The following is the analysis of questionnaire results.

This questionnaire raised a total of 152 people participated in the survey, of which the age over 35 years old accounts for 84%, and which is only 3% of total do not living with their families. Besides, the percentage of family member has three or more persons are 85% and, in which half of the people are working outside. By the way, the highest answer rate is the scope 45 to 54 years old about 66 %. In fact, 35-year-old is a critical age because their parents are usually at this time have been or are about to enter old age, they will be forced to face the problem of caring for the elderly. It can be seen that in this questionnaire, most of the investigated objects are consistent with the target groups in this study.

So, it represents that the results of this questionnaire survey have absolute reference value for this study.

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Do you or your parents have in long-term medication? no (13%)

The degree of recognition of each function of the device.

Track

96%

Update & share

94%

Indicate

95%

Emergency

94%

not sure (3%) yes (84%)

Have you worried about your familys occur emergency at home?

no (7%) yes (93%)

90%

Overall

25

50

75

90

%

There are 88% of total started or been starting to worry about their own or their parents' health, while for this device allows children to remote tracking their parents' physiological state through the smart phone, and there are 96% of total believe that the device would help children can easily care about their parents' health problems. Additionally, there are 74% of surveyed objects or their parents have suffered chronic disease, and also there are 84% of them have treated in long-term medication. Consequently, there are 94% indicated that the feature of this device can record the user's physiological state and upload them to the country's medication record cloud system, moreover allows medical staff in the conditional eligibility can read these personal physiological information would help them or their parents have the more opportunity to receive better medical diagnosis. On the other hand, the function of this device for indicating medication, there are 95% think that it would help them or their parents to reduce the chance of medication errors. Additionally, nearly 93% of the people ever worried about them or their parents happen unforeseen accident at home. Therefore, after the survey, 94% of the people agree that an emergency notification feature of this device would let them or their parents' better-assured stay alone at home or go out. Finally, there are 90% of the respondents think that they have these requirements and also feel this kind of device or system is applicable for them.

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current related law in Taiwan is strict and unrealistic but share with family might be Ok in Taiwan Privacy Security need to establish person consent mechanism

4.3 Discussion In spite of the fact that the information on the network are endless, if just unilaterally search someone's conclusions and views from the network, which contrarily lack of opportunity to interact and communicate with people. Not to mention this is a unique research topic, it is absolutely necessary to explore more specialized knowledge and an exact understanding of public opinion to make up for deficiencies of certain areas in the study. By the opportunity of this primary study to directly communicate with experts and public, and to make the exchange of each other's ideas and opinions, which get a lot of harvest and satisfactory results. And the results are summarized below.

While on personal data security laws in Taiwan has conditional limitations and constraints to collect personal information, but basically just been personally agree on it. However, personal information about special areas like medical data, the law in Taiwan is a bit vague. After all, in the past there is no such technology and ideas, so to face the future development trend of the mobile health industry, the flow of personal medical information is imperative. Even if the current related law in Taiwan have too strict and unrealistic place, but on the practical operation, the collection and use of personal information should according to the basic requirements of the individual consent. Therefore, the system must be designed to establish a personal consent mechanism. Broadly, based on previous studies in Taiwan, most of the elderly are willing to let their children participate in their own health, so that personal medical information sharing issues in this project should not be a problem.

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complicated using medicine condition need professional pharmacists help Medication problem

can collaborate with professional medicine kit

Through direct communication with the pharmacist to learn that each person's medication habits and processes are indeed very confusing and complicated. When patients took the medicine home, how they to take the medicine have been unable to control; not to mention a lot of people use nonprescription drugs as well as health food or herbs. And this kind of information is not recorded in the NHI medication record system, so it is hard to fully protect their drug safety. To summarize his views, this system does help to improve the condition of chronic patients. On the other hand, the fact is that patients in private have complex using medicine condition. If there is no professional staff to be responsible for the integration, it is difficult to control. But the innovation technology combines with cloud medication record system to indicate the patient medication that might solve this problem. Such as, the collaboration of prescription medication and professional medicine kit is an effective solution to reduce medication errors. But the medicine through other ways would have to make more in-depth study.

The statistics of questionnaire survey show that 84% of respondents are the target group, which demonstrate highly consistent with the value of this questionnaire. And the results show that most people are looking forward this product, the response for each function of the system is also satisfied.

The most important thing is that there is up to 90 percent of respondents believe that this product meets their needs.

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5. Design & Development

41

5.1 Identify project requirement Since the study passes through the previously layers of exploration and survey, so that it gets some results in this topic. Therefore, before to enter into design and development process, it needs to clearly make reorganization from the all study results and identify the project requirement.

The design brief of this project is that integration of cloud medication record system and mobile health technology allows their children through smart phone applications to remote tracking the physiological information from parents worn wearable devices. Thereby allowing their children away home to work can feel at ease grasp the real-time physiological state of elderly parents, when occurred the accident and emergencies can instantly respond. In addition, the function of the combination of cloud medication record system is that wearable device can receive the signal from the medication record system on the cloud, and to notify the exclusive medicine kit to instruct patients to use. More specifically, the device is also in accordance with the patient's physiological information to prompt medication timing and the right medicine to reduce the chance of medication errors. Another combination of features is that it be able to prolonged record the user's physiological data and upload to the cloud medication record system to allow doctors and pharmacists take these data to make more accurate treatment and prescription. Moreover, for patients who suffer from chronic diseases have a substantial help. Subsequently, the next step is based on design to use basic 6Ws discovery tool to explore more prospectively detail for the consideration to generate the design opportunity.

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• Who

• Why

Because the using object of this device

Investigate why the elderly have such

is elderly, it needs to consider this

a high medication errors and repeated

target group in this device, especially

medication opportunities, by means

the human factors involved in product

of for understanding of the elderly

design for the elderly, which consist

medication habits to find out some

of vision, hearing, psychophysics and

common ground and some improved

memory, cognition, and control as

opportunities by using this device.

well as display, in order to improve the practical operability to the elderly.

• What

• How

What kind of medicine or health food

How to use wearable device to

or herb and home-used medication

perform on the user? Survey the extent

device serve in the recent market? Not

of present wearable devices have

only understand how these medicine

been developed and find the most

are classified, also what can be the way

appropriate technology can be applied

to manage. And how do home-used

in the detection of physiological for

professional medication device assist

elderly suffering from the chronic.

patients medication?

• Where

• When

Where is the elderly's living

When do these technologies may be

environment? Search for general living

actually applied? Searching for several

environment of the elderly in Taiwan,

technologies can support this mobile

and to study what are the dangerous risk

health technology, and illustrate a

factors of this environment for elderly,

timeline to predict an appropriate time

and how the role of mobile health

of this project can be executed in the

technology occurs in this environment?

future.

In addition to Taiwan, where else have similar living conditions?

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5.2 Analysis & Survey 5.2.1 Human factors involved in design for elderly Obviously, the object of this study is the elderly, therefore, in this section is concerned about the elderly human factors and to use this point of view to examine and to build all of the design objectives.

The sequence is beginning at sensory are vision and hearing, and the next is from perception, memory to the cognitive psychological. Finally, to sum up all the above findings are able to provide some proposal to apply to the elderly user interface. Also, these findings will become the principles are followed by the all design directions.

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5.2.1.1 Vision Along with development of information technology, the most important thing between users and products is that the communication of users and interface. Products by the interface to achieve the purpose of communicating with the user; therefore, when the visual physiological conditions of the elderly gradually changed, to provide an appropriate user interface is very important. In view of visual degradation is one of the most common aging phenomenon that began at the 40-year-old (Hawthorn, 2000). Furthermore, the visual ability is that the main function of human's identification of around objects (Pratt et al., 2000), and according to a study 50% of elderly people has different degrees of vision changes (Guire et al., 1996). United States made the survey for the elderly shows, there are 20% of the elderly whom age over 65, and 26% of the elderly whom age over 75 are all have the vision problems (Institute, 1995), of which are cataracts, glaucoma, diabetes and other major factors causing visual lesions of elderly. Due to the aging so that the amount of light passing through the pupil are one third to the young people (Lemme, 2002), while the decreasing of ability of retinal photoreceptor cell causes the elderly's sensitivity also decreased significantly (Echt, 2002). In addition, elderly are more difficult to adapt the sudden change in ambient brightness (Kline & Scialfa, 1996), in the mean time, also to reduce the sensitivity of color, the interpretation capabilities of the mid tone will be reduced, especially in the range between blue and green (Helve & Krause, 1972). Therefore, the design of the elderly products, in addition to providing the appropriate product brightness and contrast, but should avoid using mid-tone colors to improve elderly's use of performance.

Vision is a primary perception of all types human feeling. Taking into account that the situation of the elderly visual decline, the elderly product design must meet the requirements of the following conditions.

Vision problems of visual degradation:

45

40

years

STRONG CONTRAST

• When a person's age over 40 years old, the function of the controlling pupil muscles will gradually degenerate, so the adjustment of light intensity of elderly's eyes is low (Fozard, 1990).

• Due to the lens degradation, in order to let elderly see clearly, it needs a stronger contrast.

• With age increasing, the lens of the eye not only becomes relatively turbid, but also will gradually turn yellow. It makes eye faced blue, purple and green reduced sensitivity (Helve & Krause, 1972). However, the solution is increasing the stimulation of the eye, such as, strengthened lighting. Nevertheless, the elderly's visual sensitivity for yellow,

• In terms of the color recognizable, the study showed that the recognition ability of simple black and white text and background color is higher than the recognition ability of colored text and background for elderly (Charness & Bosman, 1990).

orange and red is higher.

• Because of elderly's physiological degradation, the elderly population suffering from more and more increased, while cataracts, glaucoma, diabetic • Decreased visual acuity will result

retinopathy and aging-related macular

difficult to perceive the details or need

degeneration are the main cause of

longer observation time (Welford, 1985).

elderly blindness.

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5.2.1.2 Hearing Hearing aging is similar to visual degradation which are both elderly performance decreasing. The reason is that the sound through the air to vibrate the ear bones, and passes through the middle ear and inner ear to spread to the brain by the auditory nerve; additionally, the amplitude decides the sound intensity, and the frequency determines the pitch. Increased age lead to deterioration of endocrine function of the external ear skin, so that the earwax hardens cause the sound conveying is affected (Fisk et al., 2009). Generally speaking, hearing from 10-19 years of age began to decline; the decrease is more intense with increasing age. In about 50 years old will feel hearing loss, to about 70 years old hearing recession is more evident (Czaja, 1996), which because the male long stay in the working environment, so in elderly time men's hearing will be worse than women's (Fisk et al., 2009).

Fozard (1990) pointed out that the percentage of hearing loss from 45-54 years old to 75-79 years old have from 20% raised to 75%. Different age elderly have different characteristics in receiving sound frequency and volume. For example, 70-year-old man to hear the voice of 8000Hz, the amplitude need 60 dB, but the same frequency to the 60-year-old only need 40 dB (Sha, 1996). On the other hand, the speaking ability with age increasing will become less clear, it is probably because of the lower ability of movement muscle control of tongue and lip, or maybe due to hearing impairment, self is difficult to distinguish what he said whether consistent with others to hear.

The following are three relationships between hearing loss and sound.

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• The relationship of hearing loss and volume With age increasing, the smallest audible value will rise.

Coren (1994) found in experiments, the preference of loudness are different in various groups, with age gradually increasing the requirement of the amount of

LOUD SOUND

decibels gradually rise. That elderly is easier to identify the high-amplitude / high-loudness sound.

• The relationship of hearing loss and the frequency Due to increasing age the ability to hear particularly high pitch tone has reduced at all tone frequencies (Rockstein & Sussman, 1979). The minimum threshold of elderly hearing loss is above 2500 Hz, but the

500 - 1000 Hz

maximum ringtones of general phone and smoke alarms are about 4000 Hz. So, this is valid for young people but for the elderly may be invalid (Berkowitz & Casali, 1990). It follows that elderly product should be required to use a lower frequency sounds. Huey (Huey

LOW-FREQUENCY SOUND

et al., 1994)was found that the audio frequency range between 500-1000 for the elderly is in terms of the most effective. That elderly is easier to identify the lowfrequency sound.

• The relationship of hearing loss and speech velocity Elderly's ability of understanding speaking is not as young people, if the speaker's pronunciation is not standard, it is a more severe test to treat elderly hearing. While, the study also pointed out that there is a significant impact difference between both young and elderly populations in speech velocity, and the ability of receiving a faster speech velocity for elderly is not as good as young people (Sharit et al., 2003). One of

SLOWLY PROCESS THE SOUND

the reasons cause the declined speech understanding is that the elderly is slower to process the sound (Fisk et al., 2009).

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5.2.1.3 Psychophysics & Memory In this section discusses the perception stage, which is the program of mental information processing when physiology affected by external stimuli. And perception stage not only includes the perception but also consist memory and learning ability. According to relevant research indicates that the time of visual and auditory information processing will increase with increasing age (Huang, 2002); the reaction time is fastest in about youth period, but because of the elderly's sensory deterioration increases the time. So it makes the elderly receiving and determining things slower than younger people a lot. Due to the aging of the human body is not just the trunk or sensory function, also brain and memory function will change when the age grow (Smith, 1996). And that's not just for unfamiliar new things even for known things to easily generate forget phenomenon. For this reason that is why elderly in their daily lives the most common is memory question (Kausler, 1985).

The memory can be divided into short-term memory and long-term memory; Short-term memory message storage time is about 60 seconds, which for messages storage has temporary, dynamic and operational (Yang et al., 2001). Hoyer and Rybash (1992) found that with increasing age, shortterm memory would become more sluggish. Accordingly, Howard (1996) believed that when the task increase the available memory load, the impact of age would be more significant. Another study pointed out that the age more elder the auditory memory reaction would much better than visual memory reaction (Botwinick & Storandt , 1974). On the other hand, long-term memory means information stored more than one minute, and the longest memory can save lifelong memories (Yang et al., 2001). Long-term memory tasks differ with age, showing varying degrees of damage.

49

• Both instantaneously Information discriminating capability and complex • The elderly have low attention and

information discriminating ability reduce.

concentration, and they are hard to long

As well as at the same time pay attention

time maintain attention (Vercruyssen,

to two or more complex tasks ability also

1997).

reduces (Hartley, 1992).

• Memory capacity follows the degradation of visual adaptation to slow

• Semantic memory does not decline by

down the stimulus encoding speed.

aging (Crooke & Larrabee, 1992).

• The memory would be affected with aging are that episodic memory, working memory and spatial memory (Denny et

• The time-based work will be more likely

al., 1992). Such as, the human face or the

to be forgotten than the event-based

memories of map route.

work (Fisk et al., 2009).

Past studies have found that for the elderly the ability of simple identifying a particular item from similar projects is only a slight decline, but the ability of recalling the content is obvious recession (Rybash et al., 1995). In addition, another study found that when the elderly data input would not make more mistakes than the young people, but if the content is too much or complicated would perform poor accuracy, thus, reducing the complexity would make the elderly operate easily (Park, 1994). However, the designer is difficult to design for different levels of reaction attenuation because of different levels of degradation of each elderly (Czaja & Sharit, 1999). So it can be seen that the decline of perception and memory may cause the elderly difficult to learn new concepts or technology or complex procedure. The above 6 points are the summarized impacts of the perception by aging.

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5.2.1.4 Cognition Cognition means the type of message as well as approach of process, in which the message means the information with the knowledge stored in the memory; process refers to approach of obtaining, preserving and using the message (Zhong, 1999). Deterioration of cognitive function belongs psychological; elderly cognitive degeneration makes them operate products and mechanical to require a longer reaction time that affects the learning of technologies. In fact, it is normal that after 60 years old will lose intelligence, memory, and the speed of understanding of which analytical capability, judgment, and computing capability will be reduced to the original 75% to 85% (Liao, 1992). In the past the acceptance of information products is generally low for elderly, the possible reasons are: low using frequency causes lack of opportunities to practice repeatedly, so leads to unsuccessfully operate; IT products use multi-function type, resulting in high operational complexity or lack of past experience about the using information products, hence, can not produce the correct operational mental models. The changes of psychological characteristics also lead the elderly to differ behaviors, thereby affecting the safety of their operations. As similarly as physiology, psychological characteristics will also increase with age and functional decline. Which the product safety awareness greatly affected the psychological function is memory, attention and observation (Chou, 2005).

Due to the above psychological function degradation, leading to the elderly in terms of decisionmaking operational behavior will tend to be conservative, and the operating mode Would tend to

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choose familiar habits way; for the unfamiliar, a new product or behavior patterns change would feel insecure and to generate fear and afraid to try (Wu, 2005). Today's product early in the design often ignores the needs and characteristics of the elderly use, resulting in difficult to operate. Therefore, product interface design should enable elderly to increase confidence and reduce anxiety to learn new technologies (Findlay & Gilchrist, 2003). On the other hand, the specific activity may cause an error existing in the design of many products, referred to human error (Stantona & Baberb, 2002).

Swain and Guttmann (1983) believed that wrong human behavior could be attributed to a few points: an error occurred while providing message, an error occurred while receiving messages, an error occurred while processing message, an error occurred while responding message and an integration of all conditions. And most of the errors are because of a complex system caused potential errors, for example, shortage of equipment awareness with training, lack of design, machine operation failed and unclear procedures (Stanton & Baber, 1996). In addition, the related research has proven that for the elderly when the task is to have three times or more times actions most often occurs problem (Mead et al., 1997).

When elderly to use IT products should emphasize the following (Lee & Liao, 2003):

• The messages displayed on the screen must have understandability.

• Avoid the chance of human error.

• Interface complexity, consistency, and language selection.

• Considering the characteristics of the elderly, such as action, cognition and perception.

• Further explore the relationship between the buttons and the display screen.

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5.2.1.5 Control & Display Controller settings as well as display screen showing all affect the interaction between the user and the interface. While, the user interface design is the comprehensive performance design of controller input and display output. Elderly aging causes degradation of physical and psychological function, so in the interface design is also required to make adjustments for the elderly characteristics; the design must be considered to elderly's motor function, perception function, cognitive function and psychological state. To start with motor function due to the recession of elderly muscle, action dexterity, speed, strength and endurance, and it need to be seriously re-evaluated into the elderly product design, which includes the clicked position, number of times, the shape of button and the design of the input device. Secondly, recession of perception function is due to organ aging of receiving an external stimulus, the interface design should pay attention to the design related to visual, auditory, tactile and perception of operation, which direct impact is the color contrast, icon size, related auditory feedback and so on of product interface. Next, cognitive function need consider the elderly comprehension, working memory and intuition consistency; the design of operation is aimed at intuitive operation, reducing memory cognitive load and avoidance of excessive button (Elisma et al., 2004). Finally, the elderly operates information products, in the condition of absence of relevant experience is easy to cause psychological burden on their operations. Therefore, interface design need to be considered understandability of its system structure and proper to give prompt feedback. The following is a summary of all of the above human factors survey to propose the elderly interface design principles:

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• Reduce the use of athletic ability: Control position should be as close as the location of elderly users.

• Use a high amplitude and low frequency sound (Huey et al., 1994).

• When found the target, provide additional feedback or tips (Michael et al., 1999).

• Avoid using the same chromaticity and the colour of blue to green range (Charness & Bosman, 1990).

• Place the most important and the most frequently used buttons in a most easily operating location (Pirkl & Babic, 1998).

• Reducing levels: Most of the features are available under a two-tier system framework (Sorg, 1985).

• Information must be easy to understand and reduce the burden on working memory (Hawthorn, 2000).

• Products function and information provided from the products need keep in consistency (Lee & Liao, 2003).

• Provide a mechanism for the user to adjust the controls: for example, adjust the volume, speed of interface presenting a message.

• Elderly required longer operating time, so it should lengthen the time of interface presenting message (Takemoto et al., 1999).

• Increase the size of the text and the contrast of the screen background; conversely, reduce the glare on the screen (Kosnik et al., 1988).

• Provide sufficient input mechanisms exercise: Practice will improve performance and can reduce errors and flexible operation (Casali & Chase, 1993).

• Provide adequate lighting and contrast to the products is a consequence of greater demand for elderly photopic degrees (Pirkl & Babic, 1998).

• The elderly due to finger tactile nerve and continuous action slowed down, the studies have pointed out that the elderly use concave buttons have better performance (Sorg, 1985).

• Due to the decline of elderly perception function, thus providing diversity of input and output mechanisms (Czaja, 1997). For example: voice-assisted interface can help the elderly to understand the content, but must with a slower speech rate.

• Use simple and high correlated image: Symbol performs better than the language symbolic, because it does not require recodified, its identification and reaction is all faster than language symbolic (Sander & McCormick, 1987).

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5.2.2 Elderly medication habit survey At present, in addition to Taiwan, Europe and the other countries in Asia have medication errors problem. And this problem is likely to cause a considerable number of medical malpractice, hospitals and patients have caused considerable distress. In fact, medication errors are defined as "one kind act or idea mistakes." Patients since beginning to enter the clinic to receive the treatment and to get medication, if any step in this process had a little carelessness, it is possible to occur improper drug used causes patients harm (Wu, 2009). Additionally, complete drug treatment program includes: 1.

Physicians prescribe, 2. Deliver prescription to the pharmacy, 3. Pharmacists dispense, 4. Monitoring the situation of after drugs used (Chen, 2007). Where the work from 1 to 3 rely on Taiwan hospital cloud medication record system that is combined with Internet technology to establish cloud database, which allow doctors and pharmacists to more effective cooperation. And through reading the patient's medication history records to reduce the repeated dispensing and drug interactions incidents (Department of NHI, 2013). However, to the item 4 it would be difficult to prevent and track the Individual patient's drug used situation (Chen, 2007). In particular, due to the general elderly suffering from multiple chronic diseases requires long-term using multiple drugs, and for the following reasons is why these physiological problems led to medication error: 1. Memory degradation and forget medication, wrong medication or self-adjustment of medication time and amount, 2. Declined sensory function impacts the visual identification and reading difficulties as well as hearing disorders occur mistaken listen, 3. Both parties have poor communication, or by external environment sound interferes correct message receiving leading to unclearly hear the doctor guidance (Wu et al., 2002).

Finally, the survey about the elderly medication can be found, the first situation is that the elderly get the dispensed drugs will face timely medication or medication issues of multiple diseases. In addition, elderly have a lot of problems about aging causes some involuntary medication error, so that there are a lot of relevant studies for medication compliance (which need as high as 95% in order to achieve the effect of medication). Which the reasons may include the following (Bates et al., 1999).

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• Self-prescribe: taking previous • Medication interval errors: interval of

drugs or go to a pharmacy to buy non-

medication too often or too long.

prescription drugs.

?

• Taking multiple drugs at the same • Mistake of medication instructions:

time: seeing different doctors at the

misunderstanding of the medicine bag or

same time or self-medication increases

medical staff instructions.

drug interactions.

?

• Lack of knowledge of medication: self-increase or self-decrease the dose, such as fearing the side affects to self-

• Forget medication or repeat

reduce the amount of drugs. Or a wrong

medication: memory loss is due to aging,

value, which believes medication, could

leading to either forget or repeat to use

cure the sick and if no disease could

drugs, or fear the side effects to not dare

strengthen the body causes medication

the medication.

abuse.

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5.2.3 Home-used medication device survey Annual medical errors occur with drug-related, which the largest proportion is the elderly (Cheng & Liu, 2004). The elderly suffering from various diseases while taking multiple medications, due to the lack of proper medication knowledge and fearing medication, so they self-prescribe, mistakenly believed the recipe, or share medication with others lead to adverse drug reactions (Neafsey et al., n.d.). However, the most commonly prescription drugs are cardiovascular drugs, anti-anxiety drugs, sleeping pills, painkillers. Also, the elderly is the group for high used non-prescription drugs, which some elderly take one or more than one non-prescription drugs everyday, and the most commonly used non-prescription drugs is painkillers, vitamins and so on (Su, 2002). Moreover, because herbal products advertised natural, which were taken a lot of in Taiwan (Lankin, 1999). And in this case of pluralistic medication, most people do not know the pharmacist in community pharmacies provide public medication knowledge and counselling service. Furthermore, the purpose of this service is to reduce occurring improper drug using situation. But the most important thing is to improve the elderly drug compliance; it is including the understanding of the patient's cultural background, lifestyle, financial ability, family environment, and ability to self-medication, literacy and reduces the complexity of drugs, etc. In addition, in conjunction with relevant auxiliary tool such as medication kit, drug card, medicine bag dispensing drugs, drug labels to assist patients to use drug safely (Huang, 1996). Aiming at the survey of current auxiliary tool designed for elderly medication to discover that there is a kind of smart medication kit ideally suited to collocate with the system of this study. Next is the introduction of this medication kit features (Chien, 2010).

First of all is dispensing, the patient's family or the patient will place the correct medicine by each period in the kit to achieve the purpose of separately pre-placing drugs. Then its electronic system can display warning lights and open the cover of a corresponding drug case in a medication period, on the other hand, to remind patients through medication reminder devices. At this time the patient can take medicine within the correct drug case, while other covers of the drug lattice will of course show close, so that patients can avoid open the wrong cover to take the wrong medicine. In addition, every drug case have a sensor can sense whether the cover is opened or not. If the cover has not yet been turned on when it reach the medication time, the control system will send SMS to a designated person's phone, and notifying them concern the patients with medication.

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SimpleMed

Master Panel

VAICA

NTUME MEMS

Medication Adherence Cloud Platform for Service Providers A weekly medication organizer designed for home use, with GSM connectivity and built in hub* for telehealth devices. Pills are loaded manually by the patient of caregiver.

Through drug information database, the dispensing system will be able to give the user most accurate and fast dividing drug flow. During the treatment, the hospital can by medication database system records to determine the patient's medication situation and give advice.

Automatic Pill Dispenser

MedEye

Pill Organizer

Mint Solutions

ONE Week's Supply Of Pills Up To FOUR Times per Day.

Simply puts the medication into the device and gets "ok" signal will done.

Three different alarm Tones and a blinking light alert the patient when medication needs to be taken and will not turn off until the pill dispenser is tilted on it's side to dispense the pills.

The MedEye™ Solution fits perfectly with any workflow and IT infrastructure and requires almost no training for the users.

Simple, easy, patient safety.

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5.2.4 Wearable devices survey For a long time, reduce chronic diseases has been a major challenge facing the health service. But now, by means of the emergence of Internet of Things (IoT) and a major breakthrough in wearable technology which is expected to greatly improve the treatment of chronic diseases (Villasenor, 2014). Through based microcontroller, application processors, as well as portable medical devices with the cloud and other network connections, hence, IoT enables people to easily, accurately and continuously collect and share patient health information (Huang et al., 2004). These interconnection devices can automatically track the patient's vital signs and activities, and further detect the changes of potential problems that may occur. The medical device can automatically track the patient's vital signs and found that it whether has complied with the conditions of treating disease. For example, medical patches and sports watches can collect patient information. Moreover, wearable devices can automatically solve the problems of that patients need to understand what, when and how to measure the complexity of instrument operation. And, of which many devices use a ring, a watchshaped and other shapes, but no matter what kind of shape, the important part of the design is battery life and low power performance.

For the most common chronic illness need to measure the following several parameters:

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• Blood Pressure Hypertensive patients have to measure systolic, diastolic, and mean arterial pressure and heart rate. Currently, new technologies of small no-bandage sensors are being studied, such as a wearable Photoplethysmogram (PPG), which load a novel height sensor (Shaltis et al., 2006).

• Blood glucose C urre ntl y continuous monitor ing the bl ood gl ucose technology has appeared on the market and other various non-invasive techniques, for example, electronic or ultrasonic enable through the skin to measure the blood glucose, and spectroscope can use light to pass through the skin to measure.

(Yilmaz et al., 2013).

• ECG For patients with cardiovascular disease usually requires electrocardiogram (ECG) measurement through two main electrodes to identify a pin and a single reference electrode pin.

Besides, wearable ECG chip is already in the market, and the other as a ring heart rate sensor also being developed (Nemati et al., 2012).

• Pulse oxygen saturation For any type of patients with chronic obstructive pulmonary disease (COPD) and other obstructive pulmonary disease, asthma, lung disease, or certain blood disease can be used diode logarithmic through formula obtains partial oxygen saturation and also supports acquisition PPG (Chen et al., 2010).

Finally, collecting sensor data and then perform some basic algorithms, and simple data analysis, including real-time high-precision measurement and transmission. Additionally, follow the Continua Health guidelines to ensure that medical device interoperability. It needs to have a USB or Bluetooth device or other such short-range wireless communications (NFC) technology. Therefore, all the interoperable devices connected the network that can establish a very large medical devices network.

IoT in coordination with wearable device enable patients to be able to control and actively participate in their own treatment and recovery; it will reduce the social and economic costs of busy hospital doctors and nurses. More specifically, it change the past role and activities only be performed in the hospital and to move into the patients' home, also help to improve the patient caring (Tang et al., 2004).

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5.2.5 Elderly living environment survey There are more than 68% of the Taiwanese elderly are living with their families at home together, but because the family works outside for a long time, elderly during the day at home is alone state (MOI, 2009). However, due to rapid changes in the population structure, the family living pattern in various countries are very different, after an investigation and found that the family composition of India and Brazil, are similar to Taiwan; in particular, the living condition of the elderly in South Korea is the most similar to Taiwan. Indians believe that the foundation of religion and culture are more important than purely economic basis and therefore they very pay attention for family values, so most of the elderly live with the next generation, even in the city remains the same (Ara, 1997); in Brazil, 85% of elderly persons live with the big family, due to the impact of socio-economic factors, big family can share the cost of the necessary living conditions (Ramos et al., 1993), fewer cases of one person for living alone. And South Korea although there are 81.2% of the elderly living together with their families, the situation of one person living alone continues to increase, moreover, there are 13.9% of people lived with the elderly who hope when they growing older they may live with their next-generation (Kim, 1997). It can be seen that South Korea and Taiwan in this respect of family values and living pattern are quite similar. Accordingly, there is no doubt that home security of these elderly needs extra attention.

In addition, the most common dangerous situations for the elderly at home are (Kuo, 2001): wipe furniture high chair booster to increase their risk of use; lack of lighting at night causes at midnight too dangerous to go to the toilet; forget the medication time; wet bathroom leads to easy to slip; easy to be stumbled by the ground wires; methane and carbon monoxide leak; ringtones or other tips device is not obvious. At present, IoT are gradually entering a new era of computing technology, the future living environment can take advantage of the network to connect smart devices, objects, environment and other infrastructure to make it easier to interact and communicate with each other (Villasenor, 2014). So rely on interoperability of these devices, it might be able to become a very complete family safety device network.

61

62

5.2.6 Technology timeline In the past 10-15 years there have been many companies and academic institutions are working to develop more medical services, which can be linked through a smart device to wearable sensors and medical devices (Comstock, 2013). These devices not only allow shorten the distance between patients or medical service personnel with their families, but also real-time monitoring the health status of the patients.

According to Accenture 2014 State of the Internet of Things Study predicts 53% of consumers already owning or planning to purchase a device that is an adoption of wearable IoT technology such as smart watches and fitness devices by 2019. Also, there are 69% of consumers planning to buy in-home device, but currently, just only about 4% of those surveyed own such a device. In addition, the survey results show that consumers in the next year are more likely to buy emphasizing the health as well as safety connected devices, and they are most concerned about is how IoT can provide integrated product and help them live more convenient (Natgranato, 2014). Therefore, in the future five years, it expected those related technologies have been mature enough and to upcoming put into wearable medical devices market. The following diagram shows the timeline is used to introduce the development timetable about wearable sensor technology of chronic medical.

63

Vital Sign Monitoring Wireless body sensor networks

2008

Home blood glucose biosensors

2005

Monitoring Blood Pressure Accuracy of radial artery blood pressure determination

1999

2005 Radial artery blood pressure determination between the device and invasive 2005

Cuff-less and noninvasive measurements of arterial blood pressure

2005

Calibration of the photoplethysmogram to arterial blood pressure 2006

Cuff-less PPG-based blood pressure monitor with novel height sensor

2006

Ambulatory blood-pressure monitoring

Monitoring the Blood Glucose Levels 1998

Phantom glucose calibration models from simulated noninvasive human near-infrared spectra Noninvasive for transdermal glucose monitoring

2005

2009

Non-invasive glucose monitoring of skin

2009 Turbidity-corrected Raman spectroscopy 2010 Spectroscopic monitoring glucose

Monitoring the Cardiac Activity The evolving role of ambulatory arrhythmia monitoring in general clinical practice

1999

A direct comparison of wet, dry and insulating bioelectric recording electrodes

2000

Dry electrodes for monitoring of vital signs in functional textiles

2004

2010

Wireless Non-contact EEG

Monitoring Respiration 2008

Film-type transducer materials PVDF and EMFi

Multi-Parameter Monitoring A wearable multipara meter medical monitoring and alert system

2004 2005

A wearable health care system based on knitted integrated sensors

Wireless Technologies

2007

2008

Wireless body sensor networks

2008

Wearable medical systems for p-Health Wearable Antennas with Varying Distances 2009

1999

2004

2009

Radio Propagation Study

Now

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5.3 Insight & Objectives After using the basic designed discovery tool 6W to investigate about a integration system of cloud medication record system with mobile health technology to assist the Taiwan elderly prevent medication errors and living safety and through the elderly human factors point of view to analyze the relationship between those, there are some insights generated. This section would summarize these insights and propose some objectives to achieve the design aim. • Lack of medication management The first issue is complexity of medication that is too complicated for the elderly to remember how to take the right medicine at the right time due to the degradation of memory with cognition. Next is self-prescribe that is because the elderly is able to easily get the drug by variously unregulated ways and therefore not only leading to medication interaction to affect the physiological but also wasting the resource of medication, of course these are caused by lack of medication knowledge. In fact, general elderly have wrong medication concept resulted from their low education level and aging perceived functionality, which so that they misunderstand the prescription, medical advice or drug labels. In brief, it must be attributed to the entire pharmacy system is deficient in management of elderly medication, and it lacks to make good use and integrates the physician counseling services.

Therefore, the system shall combine these services to perform the elderly medication management.

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• Medication prevention device The current market have a smart medication aid device that can efficiently remind the elderly to take the right medicines at the setting time and prevent them to eat the wrong drug in the inappropriate moment. However, it still have some room to improve, such as, dispensing medicine mechanism and timing reminder function. Although this kind of device follow the elderly human factors simplifying the process to avoid elderly medication errors, on the other hand, it do not take into account the process of dispensing errors by general people may occurs. Moreover, due to difference of each person's daily routine and physiological clock may different with the time setting on the device, so, it would also affect the efficacy of the treatment of the drug. In a word, if this system could through the pharmacist's dispense technology provide a clear guide to assist family to place the drug in the smart medication kit. Furthermore, as if it combines with wearable devices, it could through the individual physiological state sent out a suitable signal in a more appropriate time for the patient medication. • Wearable devices In the past 10-15 years, there are various wearable sensor technologies for chronic diseases have been developing to near completion as well as catch the timing of development of wireless connection, and it is expected to launch within the next five years. These excellent sensor technologies should with a view to the elderly wearing convenience integrate into one device, and this device needs conform to the elderly physiological conditions. In case of technical difficulties, all of the sensors cannot be integrated into the same device still can also take advantage of the recent development of IoT. That is all the sensors be able to connect to the home LAN and connect to the system, it can also achieve the same effect. As far as the power problem is concerned, it can be solved through wireless charging technology, which through Wi-Fi or Bluetooth low energy frequency link to devices to charge, in addition, the transmitter can be placed on the ceiling, wall or bookshelf at home that can simultaneously charge four devices in a distance of 15 feet (Sommer, 2014). At the same time this wireless charging technology would remove the burden of requiring the elderly self-charging. Also, the user interface needs to match the elderly human factors. Moreover, the complicated setting function should avoid the elderly to operate, the setting features can put on the App. • Living safety Although the majority of the elderly live with their children, the elderly nevertheless would be neglected due to children working outside during the day. Therefore, in normal situation they usually take self-care at home. However, according to the survey, there are several elderly dangerous factors particularly staying at home alone. In order to avoid occurring the emergency, such as fall down, gas poisoning without their children reaction, the device could add the motion detection sensor to detect any fall gesture or other abnormal situation (Pei, 2013). Other sensors also are able to through the home LAN to connect to the system to let their children know.

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complexity of medication forget medicaiton wrong medicaiton wrong time medication Lack of medication management

lack of medication knowledge medication interaction misunderstanding of prescription, advice and drug labels self-prescribe too much way to get the drug waste the resource of medicine

Medication assistive device

dispensary exactly implement medication timing sieze the appropriate time designed for non-elderly

Wearable device

lack of integrated technologies power problem power consumption usually takes self-care emergency

Living safety

67

fall gas poisoning

Smart medication assistive device

Medication purchase management Cloud medication record system Pharmacist consulting services Setting

The system

Tracking parents

Detect the physiological states Friendly user interface for the elderly Integrated the technologies into a wrist device Wireless charging Wireless connection

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5.4 Concepts In this section, from the product design perspective, the designs have to follow above summarized objectives and to sketch out some design concept to present the ideas.

69

5.4.1 Concept 1 • Wearable device Because the most of the physiological sensors are limited to apply on the part of wrist, the wearable design is focus on the watch-like device. Due to the above-summarized principle is basis on elderly human factors, so I remove out some complicated functions and user interface just keep the simple clock face, medication indicated warning light and tips sound. The watchband design of the device is different with others general watches, thanks to needing a sensor at the bottom to easily detect the pulse. Therefore, the watchband connector move onto the top side of watch, and there is a notch on the end of the band that is for user to easily fasten the band. Usually, the cover of the watch display the clock, but when it is reaching the medication time, the cover will appear the red warning light as well as the speaker will play the sound to remind the user to take the medicine. Another feature is using innovative wireless charging technology, the area of its sensor could deliver the electric power is whole room. Therefore, the wearer do not need to wear off the device to approach the charger sensor, it will exclude out the burden of the elderly for the device charging.

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• Smart medication assistive devices This medication assistive device is primarily designed for one-week-used. It consists of 7 rows that serves as a week and 4 columns respectively means morning, noon, night and before sleep. In fact, so far it is nothing special, it is similar to currently smart medication kits in the market. However, the most difference between it and other smart medication device is that it does not require the users to use finger digging inside the box to pull the pills out. Of course, in order to assist the elderly can correctly use of the drug, the box is linked to the medication system to receive medication instruction through the inside wireless chip to implement the purpose. Furthermore, the cover is also easy to open, firstly user will find the signal on their wearable device and then only need to follow the independently lighting notch on the medication device and lightly press it that the cover will turn up and bring the pills out. Additionally, the pills inside the box in two-separated place are able to respectively store two periods of time that is before and after the meal.

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• App user interface Actually, the App user interface of this system is quite simple; due to the requirement of the system features on the children side is direct and clear. Hence, the framework of the App requires few layers only will be fine. When the user log in the home page in this App, the first important information has to choose is the object, which is their parents or other relatives. After choosing the object, user can check their parents’ status, medication and visiting pharmacist-consulting service. And into the status checking page, there are four indexes including blood pressure, blood pressure, pulse oxygen saturation and sleep, which use expression of face to signify the status are designed is that let user easily and quickly identify their parents' real time status. Also, it can displays the week-month diagram. The next feature is medication, which is including pharmacy, dispensing and allergies history.

Pharmacy is a page can provide a QR code that is prescription of the object to assist the user help their parents to get the medicine home from the pharmacy. In addition, dispensing page displays the guideline to assist user placing the pills in the medication assistive device in the correct box; allergies history is a record offering to the user. The last feature is pharmacist consulting, which the page in a dialog mode to provide user online service to ask pharmacist some questions. Additionally, pharmacist can read the object's medication record and status to give user an accurate response.

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5.4.2 Concept 2 • Wearable device The wearable device design of concept 2 is similar to concept 1; it is basis on the same design principle from the above summarized to design. It is using the identical wrist style to wear on the body to detect user's status, but what the difference between these two ideas is that concept 2 without the connector to bind or fasten. Of which, the key design is using the feature of the rubber that is flexibility that will allow user's hand go into the device. Especially, the design of the band is cut out a special gap in the middle of wristband, and this gap is the key to tighten the device on the user's wrist.

The usage is that turn the clock base from vertical into horizontal to adjust the length of the band, due to the elasticity of rubber and the specially gap shape play a key role on this design. Moreover, other features also are clock, warning light and tips sound. Of course, it is using the same as Concept 1 wireless charging technology in the device. In brief, the main purpose of this design is to minimize the opportunity for the elderly to wear off also allowing physiological detection uninterrupted.

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• Smart medication assistive devices The innovation of this medication assistive device is that changing the allocation way of general medication assistive device to dispense the drug, users only need to follow the guide on the App and put the drug in the specified storage cassettes on it. Next, the device will connect to the system to receive medication instruction; when it reaches the appropriate time will send the signal to indicate the users to take the medicine. And what the users have to do is only press the button; the device will automatically prescribe pills to the users according to the prescription on the record system.

The advantage of it is which has a greater use flexibility that can adjust the amount of medication in accordance with the physiological condition of each user in every moment. Moreover, if users later have new non-prescription drug, it also can put them in the new storage cassettes; the system will arrange them into next medication time. At the same time the user may avoid using a wrong medication, and also when the users do not take the drug, it will notify their children.

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• App user interface The App user interface of concept 2 is integrated all the feature in the home page, the benefit is at a glance that all the instruction can be found out in a short time. The tag on the top of the page displays the user's object, and the below are four main functions that are status, medication, pharmacist consulting and setting. Additionally, each function of the home page is designed for pressing the function you want, its sub-page will slide down. The sub-page of "status" can be seen that these four physiological statuses use the vertical scale display; it is easily to identify the state level. And each item have detailed line chart enable to view, also underneath has regulator can be adjusted the chart to display the day-week-month mode. In the "medication" sub-page, there are 3 items in it; pharmacy item shows the QR code of the object; dispensing item guides the user to place each drugs into the specified entrance of the device; allergies item demonstrates the historical record for the users.

"Pharmacist consulting service" is on the third part, which provides the online consulting service and displays folder style to present each case in page by page. The last one is "setting" that sub-page show the log out, wearable device and help.

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5.5 Evaluation 5.5.1 Expert opinion The main contents of this interview is from product design perspective to view the entire design concept, therefore, the choice of expert is also based on have product design experience or background especially smart device. Expect that can take from this interview relying on his professional judgment and substantial recommendations, and makes the latter period design to access a more explicit direction.

Wei, Pau Shih Chien University BA Compal Electronics Inc. Smart device business group, industrial design department Designer Email:iforgottt@gmail.com

Pau Wei graduated from Industrial design department of Shih Chien University in 2008, and later worked in Ozaki Tech engaged Apple mobile phone related accessories design. And currently serves in smart device business group, industrial design department of Compal Electronics Inc., serves as designer. During his working time, his works can been found in Haier, Lenovo and HTC. Now, his current mission is that develop the innovative wearable device design.

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Q&A Q1: For these two wearable devices design, do you have any comments?

A1: First of all, I think your device is mainly for long-term wearing, so comfortable seems quite important, and good comfort is based on the overall lightweight and improve comfort between the strap and the skin. Nike's fuelband can be considered a fine example in this aspect of the design. So, according to your function setting, I do not recommend that you use the watch form, but should be in the form of bracelet. The most important reason is that its device function setting has been very clear, so there is no need to add other features, besides if it removes the watch screen display can not only reduce components to achieve the purpose of lightweight but also reduce the output power. In addition, I think it needs to add waterproof features; after all, bathroom is high dangerous place to occur unexpected emergency. As well as GPS positioning system can be built in it that is helpful for tracking the whereabouts of the elderly. And from product design point of view, I think the tightening design of Concept 2- wearable device design is very special, and then if some of the details deal more comprehensive and complete, it will be as interesting design.

Q2: And how about the smart medication assistive devices design?

A2: As for the medication device design, I prefer the second one. However, if it can add some interaction between it and the wearable devices, it can be more stimulation to the elderly's sensation, may have a good effect. In addition, for the shape I think it should need more friendly for elderly, and jump out of the scope of general medical devices, as home feeling.

Q3: Finally, how is App user interface going to perform?

A3: I have no other comments for App user interface, the only key are clear, simple and make people at a glance are the most important.

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wearable device

smart medication assistive device

App user interface

concept 1

1 2 3 4 5 3 4 13 35 32 350

1 2 3 4 5 1 2 3 4 5 3 3 11 36 34 3 1 16 31 36 357 356

concept 2

1 2 3 4 5 3 3 21 28 32 344

1 2 3 4 5 1 2 3 4 5 3 2 11 27 44 3 2 14 36 32 368 353

5.5.2 Questionnaires The purpose of this questionnaire is by public poll to objectively evaluate these two design concepts, and to collect some advice to provide an opportunity of adjustment and modification to this study and make it better. In this survey totally collected 87 responses, of which young people who are under 34 years of age accounted for 60% of all responding numbers. Although it is lack the views of the elderly to compare with the front questionnaire, its benefits are young people have higher acuity for technology products; hence, they can offer more practical advice and reliable score compared with elderly. The scored way of this questionnaire is that respondents mark the points for each design from 1 to 5, and finally, the more high overall score be marked, the more much favor be obtained from the public.

First of all, to start discussing from the wearable device, Concept 1 obtains 350 score is exceeding Concept 2 the 344 score. In addition, most of people advise that due to long-termed wearing, the wearing comfort should be seriously concerned about choosing lighter weight also waterproof material; moreover, one of the comments mentioned that setting built-in GPS system would easy to track their parents' movements. Next one is smart medication assistive device; in fact, two of the concepts are both to obtain great affirmation and high score respectively 356 and 368. But, concept 2 make them feel more convenience and more accurate, thus, it gets the highest points in this questionnaire. However, some comments said that if it is lack of drug storage grid how to do?

Additionally, some of them expect that have portable proposal. To end with App user interface, in this evaluation, these two concepts are nearly tied, which are Concept 1 got 357 and Concept 2 got 353. The comment said that these main functions of the App truly meet their needs. Basically, using the App for them, the most important requirement is simple, easy to understand and easy to use.

Therefore, through the investigation of questionnaire can be knew that most of respondents prefer the wearable device design and App user interface design from Concept 1 and smart medication assistive device design of Concept 2.

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5.6 Verification and revision In the design process, verification and revision is one of the absolutely necessary process, its main purpose is to be able to make more products tend to perfection through every correction and adjustment. By questionnaires and expert opinion may examine whether the design meets these expectations and needs of everyone. And those advice and suggestions they offer will be the best feedback to the designer to redesign a better product for them. In this section, will organize the above findings and re-submit the corresponding design solutions.

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• Wearable device In order to improve the comfort of wearable devices, and also concerns about to keep the simple of elderly devices, so, decided to remove the original watch function. This not only reduces the space of mechanism using and the consumption of weight, but the device can also extend the electricity storage, therefore, this wearable device will return to the most primitive form of bracelet is more appropriate. In addition, for the strap design, if it is possible to decline the area of the strap to directly contact with the skin, it will be able to effectively reduce the sense of hot from bracelet cover on the wrist skin while also improve the ventilation between these two. Moreover, due to the whole device should be setting as waterproof, hence, after taking the bath, the strap must be able to quickly drain out the water. The executable methods are that to add the projections on the inside of the strap lines or points, in order to increase the distance between the skin and the strap to reach for this purpose.

And these adjustments and modification for the long-term wearing comfort of this device will be significantly improved. In addition, considering the devices should protect when the elderly occur emergency outside, their family can find them immediately. Consequently, the GPS positioning system should be built into this wearable device. Furthermore, in terms of appearance and wearing way, it mainly follows higher score of the result of the questionnaire.

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• Smart medication assistive device The smart medication assistive device of Concept 2 obtains most of respondents’ affirmation as well as expert's recognition. But for the shape I agree the expert's advice, it indeed have a room to improve.

Therefore, the appearance will be modified that become more close to home feeling and not looks like a functional machine. For example, the indication light could be a appropriate element to create a warm symbol at home; or using lighting effects to communicate, such as, when the elderly are going to touch the medication button, the indication lights of the wearable device and the medication device will interact to produce some effect to deepen the impression of the elderly. On the other hand, also using the same type of light to project the place indicating the elderly to get the drug. • App user interface Regarding User Interface design, it is basis on the results of the survey to follow. In addition to lack of consideration of some of the details, but basically it do not have much problem; in brief, clear and simple are the important principle of this design.

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5.7 Summary To sum up, the whole system in this study is an integration of mobile technologies and cloud medication record system to assist Taiwan elderly prevent medication errors and improve living safety. The mobile technologies are including an App of the smart device could track to the integrated wearable sensors device to detect the physiological status of the wearer. And that wearable device integrated GPS positioning system and four main sensors to detect and record the data of blood pressure (heartbeat), blood glucose, pulse oxygen saturation and sleeping while the other one sensor is motion detection to sense the elderly falling down accident. Which not only lets their children to remote monitoring their old parents but also uploaded the data to the medication system makes medical staff have an accurate treatment to prescribe. Moreover, the other function of the wearable device is "indication" that is an only program the elderly need to understand, which is performed by lighting and ringing to remind wearer taking the medicine. In order to satisfy the requirement of long term wearing, the device is waterproof and able to long distance wireless charging, so the wearer does not need to often wear off. Furthermore, another mobile technology serves in this system is medication assistive device. The performance of this device is building on the cooperation of the wearable device with the App: first of all, after getting the medicine from the pharmacy, the system will through the App to guide the family to help their parents to dispense the drug into the device; lastly, the system will according to the medication records and currently physiological state of wearer of wearable device to indicate the wearer to go to the device taking correct medicine at the correct time. And because these two devices are related to the usage of the elderly, they both follow the elderly human factors design principle to achieve its functionalities. On the other hand, the App mainly serves the wearer's children to help them track their parents' state and to assist them improve their health. The features of the App are not only tracking and guiding children to dispense the drug into the smart medication device but also providing an assistance mechanism to help the user to replace their parents to go to pharmacy get the drug , and to offer drug allergy report of their to remind them to avoid interaction with other food; furthermore, there is an pharmacist consulting service, which supply to online consulting service, make pharmacist can remote reading the patient's file to provide professional advice. Last but not least, their children would through the App operate any about wearable device setting.

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Indicate

Track

+

Upload

Setting

Guide

+

Consult

83

H Share

Taiwan Cloud Medication Record System (EHR) Manage

H H

Pharmacy

The whole system framework 84

6. Delivery

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6.1 3D modeling & Rendering These are renderings of the wearable device and the smart medication assistive device, which the appearance are setting to pure colors, such as white, grey and black, but it still have detail parts to set to silver, bronze and shine yellow to appear in the unobvious part. And the part of the detail is the marrow of whole device that is the indication light and warning speaker place. Its purpose of this design makes the bracelet not to be look like a technology product, while just make it looks like a high quality textured decoration on the wrist.

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Another smart medication assistive device is designed to not look like a medical device makes patients and family feel not living in the hospital, while the interactive display be hidden in the front small holes of panel. The white appearance make patients reduces the feeling of fears of medication and be able to comply with home style make patients feel warm. And the interactive display can show any medicine information enable make patient to Identify medicine to deepen their memory. Such as, how many number of the pill should take in these times? ; Whose medicines are falling down in this moment? Etc. Moreover, the two side drug storage have up to 16 lattices to place different pills that makes it easy to store parents' medicine in one box. Furthermore, the different wearable devices could be setting to indicate differently designate colors to remind different wearers between two parents when they using the same smart medication assistive device at home. And then the display of the medication device will be basis on different wearer's indicatively designate color to show corresponding color on the screen for identification.

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6.2 App design The App user interface is designed similar with those devices, which is clear and simple to read that makes user have an association with other devices. Basically, the interface uses the white color to be a background even other layers cover on that, it only adjusts a little bit black on it and add a shadow effect. In addition, white color background makes the information clearer to identify and present a professional feeling. While its different functional characteristics uses different icons and different colors to identify.

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90

6.3 Scenario

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Love your parent, let them wear the device and make them get the better health

The device can detect and record whole day living states and enable let children to track

Even the wearers are taking shower or any other activities, the device suits to long-time wear

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The physiological data would upload to cloud medication record system makes medical staff have a accurate treatment

The children can replace their parents to go to pharmacy get the medicine, and can carefully listen pharmacist's reminder

Even occurring any accident or any question about the medication, the pharmacist consulting service is serving anytime anywhere

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The user just only need to follow the guide, and can easily dispense the drug in the correct storage box

When the indicator is lighting and ringing, just go to the medication device to take the medicine

If your parents occur any accident, the system is going to notify the signal to inform

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6.4 Further development possibilities Personal mobile technology products have become part of people's lives, Taiwan smartphone use survey found that smartphone penetration rate increase, up from 32 % last year to 51 % this year, but still lag behind South Korea (73%), Singapore (72%) and Hong Kong (63%); yet, in Taiwan about 80% of users will carry smart phones out, in this field Taiwan's the dependence on smart phones in Asia-Pacific win the first place (Su, 2013). In the past few months there is another new personal mobile technology products suddenly appeared, also gradually change people's lives, it is the wearable device. In 2013 to 2014, the market has been flooded with all kinds of wearable devices, and to provide an alternative service for people, which the service is different and impossible by the smartphone to obtain.

Furthermore, most of these technologies and services are covered by the health and sport, so, who care about the health and sports-loving young people are willing to wear these devices to record their life situations. However, although these technologies also apply to elderly to monitor their body's condition, so far in the market has not seen any related products are designed specifically for the elderly. Additionally, there is a market research firm (Research2Guidance, 2012) noted that the scale of global mobile health care market in 2011 about $ 720 million, compared to the previous year increased by 7 times estimated 2016 market size will reach $ 11 billion (Digitimes, 2014). And the main revenue of market is from mobile medical App arising out of related services and products. In particular, smart wearable devices are popular, it can provide continuous-time health information, such as sleep time and heart palpitations to health care providers and further by subsequent data analysis to conduct the related application of health management. In the future more and more manufacturers are developing mobile medical App, the health authorities in many countries have also begun to re-enact the relevant specifications. Such as the FDA in 2011 for the first time released a draft about mobile App medical guidelines to standardize mobile medical App and mobile medical App manufacturer, and to start pre-market certification mechanism to ensure the safety and effectiveness of medical software and hardware operations (Digitimes, 2014). On the other hand, due to the habit of mobile App market, the price of App is extremely low or is obtained free of charge. However, my system provides a complete series of software and hardware that "free software, charging hardware" mode in full compliance mobile medical App business models. Also, this system integrates Taiwan medical resources, Taiwan's hospital once began to import this system, it could collect data synchronously and upload clouds through massive data analysis techniques to establish a patient tracking database, so doctors can more efficiently and accurately treat patients.

Therefore, there is a great opportunity and potential of the market for this system in near future.

According to above survey, South Korea also would be a appropriate choice to execute this system.

But how to encourage health care workers and patients or their family willing to use would be the key of the future mobile health care system.

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7. Conclusion In conclusion, by the deep investigation of this dissertation can be found that the development of mobile technology indeed can improve the people's live, but only lack of integrated all technologies with resources into a system service. Nowadays, a unitary product has not been enough to satisfy the users, more importantly is what the service and management of an integrated system that be provided behind the product, and that is what customers really need and want. During the survey, this study through the gradual research and analysis has proven the design thinking is one of a possible way to solve the problem. In short, in this project, it obtains a lot of achievement, from literature reviews, project definition, design proposal, questionnaires, expert opinion, further design definition and survey, design concept proposal, evaluation and revision and final to design delivery.

Be honest, it have to say that is really a tough way to achieve a design thesis in these short period, but it is an absolutely great project to help me to assist my country to solve the aging issues and propose a reasonable recommendation to improve the development of mobile technology for the elderly. Moreover, the other aim of this project provides a design opportunity to promote innovation of future medical environment. However, it still a lot work needs to reach in the future which include the further product development and manufacture even marketing. Finally, the aim of this study is expected to reduce a lot of burden: one of these is the elderly can be benefited by participation of using technology products without difficult operation; other one is that the children can easily take care their old parents; the last one is that the government enable reduce the pressure brought from facing aging society.

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9. Appendix First Questionnaire response statistic

The survey of mobile technology for Taiwanese elderly living safety and prevent medication error.

Advanced mobile technology brings people many conveniences but just for the benefit of part of people, but in fact there are some people who still can not benefit from these, but this survey will help me complete my design, my goal is to use mobile technology to assist the elderly in Taiwan, this questionnaire survey of medical care, medication and home safety of the elderly and their families.

1. Age? Under 34years 35~44 years 45~54 years 55~64 years Over 65 years

25 17 66 33 11

16% 11% 43% 22% 7%

2. Occupation?

None Student Self Employed Employee Work at home

Housewife (husband) Retired

3 11 12 76 11 21 18

2% 7% 8% 50% 7% 14% 12%

3. Family member?

(Multi choice)

Single Spouse Children Parents Others

8 107 99 50 32

3% 36% 33% 17% 11%

4. Family size?

1 2 3~5 5

5 18 90 39

3% 12% 59% 26%

5. Have you started or been starting to worry about you or your parents' health problems?

Yes 134 88% No 18 12% If a device can help your child or you to track yours or your parents’ physiological state, this device do not need to learn how to intentionally use or operation, just feel free to wear in the user's body (ex: watches, rings, necklaces and other forms), and finally your child or you can track yours or your parents' immediate physiological state through smartphone APP (mobile application software). It may including physiological state of the user's daily routine, heartbeat, blood sugar, sleep state etc.

6. Do you think this device would help your child or you can easily care about your or your parents' health problems?

Yes 146 96% No 6 4% Other 0 0% 7. Do you or your parents have chronic disease?

Yes 113 74% No 32 21% Not sure 7 5% This device can record the user's physiological state (including the user's physiological state daily routine, heart rate, blood sugar and sleep status, etc.) and upload them to the country's medication record cloud system, moreover allows medical staff in the conditional eligibility can read these personal physiological information, the purpose is to help them to make more accurate medical diagnosis.

8. Do you think this device would help you or your parents have the more opportunity to receive better medical diagnosis?

Yes 143 94% No 8 5% Other 1 1% 9. Do you or your parents have in long-term medication?

Yes 127 84% No 20 13% Not sure 5 3%

Another feature of this device is the function that to indicate medication. It links to the medical record cloud system, and can inform the users take the medication at the right time or in the right physiological conditions, to reduce the chance of medication errors and repeat medication.

2

10. Do you think this device would help you or your parents to reduce the chance of medication errors?

Yes 144 95% No 8 5% Other 0 0% 11. Have you ever worried about you or your parents happen unforeseen accident at home?

Yes 141 93% No 11 7% Finally, there is a function that is emergency system in this device, if you or your parents happened unexpected accidents (falls, fainting, shock, etc.) in the home or outside, it can send a signal to your child's or your smart phone, so that they or you can monitor at any time and real-time response.

12. Do you think this device would let you or your parents’ better-assured stay alone at home or go out?

Yes 143 94% No 9 6% 13. Such a wearable device has the following four functions: A. Track - physiological state, B. uploading - Integrated Medical Systems, C. indicate - medication timing and information, D. Emergency - warning signals. Such a device or system that you think you (or a family elders) have these requirements and is applicable for them?

Yes No

137 15

90% 10%

Second Questionnaire response statistic

The preference survey of design concepts The purpose of this questionnaire is to assist me to objectively evaluate my design concepts, and provide me some advice to provide a opportunity for me to adjust and modify my design and make it more better. And the main system function is that using mobile technology to assist Taiwanese elderly living safety and prevent medication error.

Age? Under 34years 35~44 years 45~54 years 55~64 years Over 65 years

52 7 16 12 0

60% 8% 18% 14% 0%

Gender?

Male Female

37 50

43% 57%

The identity at the home?

Children 47 Parents 14 Both 26

54% 16% 30%

This diagram introduces the system structure and functionality

Concept 1 • Wearable device design Because the most of the physiological sensors are limited to apply on the part of wrist, the wearable design is focus on the watch-like device. Due to the abovesummarized principle is basis on elderly human factors, so I remove out some complicated functions and user interface just keep the simple clock face, medication indicated warning light and tips sound. The watchband design of the device is different with others general watches, thanks to needing a sensor at the bottom to easily detect the pulse. Therefore, the watchband connector move onto the top side of watch, and there is a notch on the end of the band that is for user to easily fasten the band. Usually, the cover of the watch display the clock, but when it is reaching the medication time, the cover will appear the red warning light as well as the speaker will play the sound to remind the user to take the medicine.

1 2 3 4 5

3 3% 4 5% 13 18% 35 40% 32 37%

Comments •Due to hand size is different for each person, how to adjust the size?

•Size of fonts should be bigger, interface should be operated easily.

•I am wondering if elderly people like to use watch-like device or we can have multiple solutions?

•Should Consider color blindness, color weakness or impaired hearing elder people.

• Smart medication device design This medication assistive device is primarily designed for one-week-used. It consists of 7 rows that serves as a week and 4 columns respectively means morning, noon, night and before sleep. In fact, so far it is nothing special, it is similar to currently smart medication kits in the market. However, the most difference between it and other smart medication device is that it does not require the users to use finger digging inside the box to pull the pills out. Of course, in order to assist the elderly can correctly use of the drug, the box is linked to the medication system to receive medication instruction through the inside wireless chip to implement the purpose.

Furthermore, the cover is also easy to open, firstly user will find the signal on their wearable device and then only need to follow the independently lighting notch on the medication device and lightly press it that the cover will turn up and bring the pills out. Additionally, the pills inside the box in two-separated place are able to respectively store two periods of time that is before and after the meal.

1 3 3% 2 3 3% 3 11 13% 4 36 41% 5 34 39% Comments •Can you put the function of sound or light to inform elder people when they need to take medicine because they normally forget to take medicine and Hearing Impaired as well.

•Medication device and informing sound should be designed to make users more acceptable when they take medicine •I thought it is just suitable to use at home if I have to bring it to outside, Volume may too big. Is it can be disassembled?

•Medication device is big for one week portion, I am not sure do I really need Portable medication device?

•It seems inconvenient to take out medicine if I looked Side, users cannot identify medicine easily •Considering Physiological degradation and cerebrovascular accident •Capacity should be large enough

• App user interface design Actually, the App user interface of this system is quite simple; due to the requirement of the system features on the children side is direct and clear. Hence, the framework of the App requires few layers only will be fine. When the user log in the home page in this App, the first important information has to choose is the object, which is their parents or other relatives. After choosing the object, user can check their parents’ status, medication and visiting pharmacist-consulting service. Into the status checking page, there are four indexes including blood pressure (heartbeat), blood pressure, pulse oxygen saturation and sleep, which use expression of face to signify the status are designed is that let user easily and quickly identify their parents' real time status. Also it can display the week-month diagram. The next feature is medication, which is including pharmacy, dispensing and allergies history.

Pharmacy is a page can provide a QR code that is prescription of the object to assist the user help their parents to get the medicine home from the pharmacy. In addition, dispensing page displays the guideline to assist user placing the pills in the medication assistive device in the correct box; allergies history is a record offering to the user. The last feature is pharmacist consulting, which is page in a dialog mode to provide user online contact the pharmacist to ask them some question. Additionally, pharmacist is according to reading the object's medication record and status to give user an accurate response.

1 2 3 4 5

3 3% 1 1% 16 18% 31 36% 36 41%

Comments •Immediate watch, Medical Records and online funding match what I needs.

•Not too complicated, or difficult to understand.

Concept 2 • Wearable device design The wearable device design of concept 2 is similar to concept 1; it is basis on the same design principle from the above summarized to design. It is using the identical wrist style to wear on the body to detect user's status, but what the difference between these two ideas is that concept 2 without the connector to bind or fasten. Of which, the key design is using the feature of the rubber that is flexibility that will allow user's hand go into the device. Especially, the design of the band is cut out a special gap in the middle of wristband, and this gap is the key to tighten the device on the user's wrist. The usage is that turn the clock base from vertical into horizontal to adjust the length of the band, due to the elasticity of rubber and the specially gap shape play a key role on this design. Moreover, other features also are clock, warning light and tips sound. In brief, the main purpose of this design is to minimize the opportunity for the elderly to wear off also allowing physiological detection uninterrupted.

1 2 3 4 5

3 4% 3 4% 21 24% 28 32% 32 37%

Comments •Is it waterproof?

•Elastic concept is good but it need to verify •Should be convenient to operate •Considering the users whose hands are difficult to move •Should have reminder device •Material should not easy to be allergies •You may have to consider that elderly people won't take a shower everyday, so the comfortable sensation must be enhanced.

•Smart medication device design The innovation of this medication assistive device is that changing the allocation way of general medication assistive device to dispense the drug, users only need to follow the guide on the App and put the drug in the specified storage cassettes on it.

Next, the device will connect to the system to receive medication instruction; when it reaches the appropriate time will send the signal to indicate the users to take the medicine. And what the users have to do is only press the button; the device will automatically prescribe pills to the users according to the prescription on the record system. The advantage of it is which has a greater use flexibility that can adjust the amount of medication in accordance with the physiological condition of each user in every moment. Moreover, if users later have new non-prescription drug, it also can put them in the new storage cassettes; the system will arrange them into next medication time. At the same time the user may avoid using a wrong medication, and also when the users do not take the drug, it will notify their children.

1 2 3 4 5

3 3% 2 2% 11 13% 27 31% 44 51%

Comments •More convenient and more accurate •Owing to several Species of medicine, how can I solve the problem if the storage is not enough •suit in different hospital but inconvenient bring to travel •Medicine should keep dry •it should be clear that how to categorize different medicine and how it produce the correct medicine to provide to users

•App user interface design The App user interface of concept 2 is integrated all the feature in the home page, the benefit is at a glance that all the instruction can be found out in a short time. The tag on the top of the page displays the user's object, and the below are four main functions that are status, medication, pharmacist consulting and setting. Additionally, each function of the home page is designed for pressing the function you want, its sub-page will slide down. The sub-page of "status" can be seen that these four physiological statuses use the vertical scale display; it is easily to identify the state level. And each item have detailed line chart enable to view, also underneath has regulator can be adjusted the chart to display the day-week-month mode. In the "medication" sub-page, there are 3 items in it; pharmacy item shows the QR code of the object; dispensing item guides the user to place each drugs into the specified entrance of the device; allergies item demonstrates the historical record for the users. "Pharmacist consulting service" is on the third part, which provides the online consulting service and displays folder style to present each case in page by page. The last one is "setting" that sub-page show the log out, wearable device and help.

1 2 3 4 5

3 3% 2 2% 14 16% 36 41% 32 37%

Comments •Should be simple to use