amr by Vivian van der Burgt

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DATE: 30/03/09

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Table of Content Research

Ideas and Concepts

Final Concept

Introduction

p. 3

Market Research Target Group Demands and Wishes I Thrombosis Thrombosis Service Demands and Wishes II Stakeholders

p. 4 p. 7 p. 8 p. 11 p. 12 p. 14 p. 16

Idea Generation Choosing Concept

p. 19 p. 24

Problem Analysis Clock Mechanism Product Description Prototype and Future Description

p. 25 p. 26 p. 28 p. 30

Conclusion

p. 33

Conclusion

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Introduction People are getting older and start to forget things. They aren’t as mobile as young people and not familiar with the new technology developments. They have to take multiple medications for the diseases they have. It is very hard for them to remember the pill intake and that is why we have to make a new medication reminder. The goal of this project is to make a medication reminder for elderly people who have a mental disorder and take multiple medications. Our problem statement was: reminding the elderly people with a subtle medication reminder. To reach this we need to ask ourselves several questions: What are the existing products? Who is the user? Which expectations and needs do they have? What is a subtle way of making a medication reminder? In the beginning it was very hard to come up with a concept because the target group was not clear yet. After a talk with our proposer Huib Vader a new target group was settled. Finally the focus should be on the thrombosis patients of the thrombosis service. Further on reported are the process of idea generations and the concepts made, the research conducted and a final product that came out.

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Research Market Research In the beginning of a project you first need to do a lot of thinking. What is the goal of the projects? What is the specific target group? What are the demands and wishes? After this is all clear you can develop a vision. The first step made was looking at the already existing products on the market. Then you see what is available and where the weak and strong points are. Three groups were made in which medication reminders are placed with the same functions. Medication reminders are the first group, which only are dispending boxes with no alarm. Medication reminders who also have an alarm besides the boxes are the second group. The third group is the more innovative devices like the ‘MagneTrace’; a device with a sensor necklace that sends the date and time a pill is swallowed to a wireless device. The device aims to increase drug compliance with the elderly and clinical drug trial participants. This device has a new function: The feedback system with the sensors that the pill actually is taken. There are many devices with the text messaging as alarm but it isn’t very efficient for elderly people. Elderly people are not familiar with the new technology devices. Because they are old they don’t have the capability to easily learn the new features, which is also what Huib Vader said, our proposer. You just have to assume that these people can’t learn or remind anything. Now the market and the strong and weak points were clear on the already existing products. The first demands & wishes for our product were made.

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Target group In the project description is said that it is needed to make a medication reminder for elderly people who have a mental disorder and take multiple medications. This is already a small target group but it is not specific enough. The elderly who are living in an old people’s home take multiple medications and have caretakers that help them with daily things. To get to know the life, the activities of the elderly and the activities of the caretakers, talking to a caretaker in an old people’s home took place and facts like the time spend on giving medication were found out. This also helped with defining the demands and wishes. The caretaker has to sort the medication every morning and has to go to the patients four times per day bringing the medication. It is very time-consuming and there lies some improvements. There were no medication reminders in use, only the patients had a necklace with an alarm button for emergencies. The problem with this was that some patients do not even wear it all the time. The caretakers do not know which medication they give to the patients. They get a role with pills with the name of the patient, day, time and name of the pill but not where the pill treats. Some patients do not think it is important which pill they get but there are also patients how know it better than the caretaker themselves. So it is not clear whether the device should give information about the pills or not. The idea of involvement of the caretakers by giving feedback to them, wasn’t really successful. It was experienced as unreliable and didn’t feel comfortable. Proposing the idea of community building (opportunity to talk about their medication and encourage each other taking the medication, kind of chat room) caretakers experienced that the people are very on their own and do not contact that much with others. The specific target group should be chosen: elderly who are living independent or elderly who need care in an old people’s home.

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Demands and Wishes I Demands: -

Pill capacity/container: That our product is capable of storing multiple pills in various compartments.

It should be able to alert/remind at any time and as many times needed: active for 24 hours, on multiple occasions and on various time(slots).

Involving the doctors/caretakers: Giving the caretakers more inside vision in their patient’s treatment by receiving feedback.

Reliable: Our device should make sure the patient gets a proper treatment when they can’t do it on their own. This makes them more independent, thus it has to be reliable and being able to provide this need. Having a device where you can totally rely on gives the patients the confidence they need.

You only have access to the right pill (and not your whole storage): The patients should not have access to all their medication if they only have to take a particular one. This prevents them of taking the wrong pill.

Device gives the name of the pill: When a pill has to be taken the device should have a way of showing the patient which pill he or she is going to take. The patient has already knowledge about what side effects it might provoke and how they have to take it, so that doesn’t have to be displayed.

The alarm should alert the patient in a pleasant way: This message should drive at least two different senses of the patient. In this way the device makes sure the alarm will be noticed. It should alarm without disturbing others or get confusing.

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Wishes: -

Different/Innovative interface other than the existing reminders: Most of the existing products aren’t innovative. They do what is needed, but nothing more. To make it more attractive for the user it has to give a new dimension to reminding you off and taking the pills.

Easy, simple: The device should be understandable for everybody. A simple system that allows you to use it without reading an instruction guide. Less buttons(interface) and less complexity.

No extra costs: There are cases in which an existing reminder forces the patient to have an account and pay monthly just to be able to use the device. This is something that has to be prevented; buying the device should cover all costs of using it.

Gives Feedback/Confirmation of actually taking the pill: The device should not only register if the alarm has been deactivated by the user but especially recognize if it is actually swallowed or not. This information could be passed on to the patient’s doctor and caretakers.

Interaction between User and Product: The patient should somehow be involved when getting alerted. The alarm is an important part of the reminder

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Thrombosis Thrombosis is a disease in our blood vessel system where a small blood clot blocks the rest of a vessel. This can have serious consequences like a brain infarction, myocardial infarction or a pulmonary embolism. Blood clotting is a natural reaction of a wounded body, but with thrombosis this reaction is exaggerated. Remedy By using blood thinners the reaction of blood clotting can be reduced to a normal level. With wrong medicine use the blood can get too thin. This can lead to serious bleedings. Therefore it’s very important to get the medicines in the right amount at the right time. When a patient takes the medicine’s wrong, they have to take vitamin K to reduce the overdose. The recipe for the medicine intake change with status of the blood. Most patients have to do a check on a weekly base, patients with a higher risk even more often. Treatment There are several ways of treatment. There is an infuse and an injection, these are the hospital manners. For independent patients there is a Thrombosis pill. A few times per month a person has to do a blood test. With the results of that test the person gets a schedule for the pills intake. He has to follow the orders of the doctor strictly.

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Thrombosis service The meeting with Huib Vader turned out in an information flow about the project. The relevant things learned from this meeting are incorporated in the way this project is run and results are integrated into the report and our research and design process. The Maxima Medical Center is a laboratorial hospital with a well-exploited thrombosis service. The hospital has a well thought system when it comes to the treatment for thrombosis. They have people 24/7 available to do blood tests and examine proper treatments. Also they decided to send caretakers to the homes of thrombosis patients who live on their own . The patients really want to take their medications properly but day by day, it becomes harder for them to remember and take the pills because of limitations. There should be a device which helps the patients with this, even if this might get forcing. In the thrombosis service car is a ‘point of care’ device, so the caretaker can do a blood-test, make an INR scheme where they put out the blood values and give the patients the corresponding medication, putting it into the patients’ organizer box. The thrombosis treatment verifies from day by day which is very confusing for the patient. Their blood is measured every week and depending on the results the medication is chosen, with the possibility that every day has different kind and different quantity of medication. And if this isn’t difficult enough, the pills have to be taken carefully and exactly on the right time. There also have to be pills with vitamin K available at all time because this pill can reduce the patients’ blood.

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The problem with this service is that it takes a lot of time and money to go to the patients home. Another problem is that even though they give the patients the right medication scheme, they don’t know if the patient is actually taking the right medication and consequently taking the right pill. They are somehow involved with the patient but this service doesn’t give the firmness thrombosis demands. Talking about firmness and insurance, the insurance companies, who are interested and have benefits with a certain device which helps patients, have to agree to put some money in this system, because the Maxima Medical Center is dependent on their share. The talk made the target group more specific. For some final facts about pill sizes, quantities and dispensing times, a second talk was arranged with Huib Vader and the Demands & Wishes got explicit.

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Demand and Wishes II

Demands: -

It should be able to alert/remind at any time and as many times needed: active for 24 hours, on multiple occasions and on various time(slots).

Reliable: active checking by the device is needed for actually taking the pill and the device reminds you when leaving the device. Also the device must eliminate human errors.

Data transfer of the blood test by a USB-stick: the effort and the time that is spend for the caretaker will be reduced and it will also be more reliable (less human errors).

Fully automated system that works fully independent: No interface for user and the medication scheme will be made by the device and organize the right pills.

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Wishes: -

Pill storage: the device needs a pill supply for average more than a month. The caretakers are saving more time for other patients and they can make fewer mistakes.

Make the device attractive so the patients use it and take it with them.

Reduce the time of the caretakers spending on the patients.

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Stakeholders Who may benefit from medication reminders? This research is done to find out why would someone desire to use a medication reminder and why would a company be interested in investing on producing medication reminders. And actually who are the benefactors of investing on producing medication reminders? Many patients suffer the harms caused by forgetting to take the right dose of medication at the right time, or forgetting to take the pill at all. So obviously penitents would be eager to have the medication reminder to help them out of this problem. “The National Council on Patient Information and Education estimates that half of all medications are taken incorrectly each year and that mistakes account for 10 percent of all hospitalizations and 25 percent of all nursing home admissions. And on a worldwide basis, the World Health Organization (WHO) projects that only about 50 percent of patients typically take their medicines as prescribed”[1] and “according to the New England Journal of Medicine, costs associated with this non-adherence range upward of $1 billion annually in hospital costs.” [2] This is an example of the negative effects on hospitals caused by the failure in medications being taken properly. So hospitals would be interested in investing in such devices and systems to

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remind their patients to take the medication properly. Hospitals also suffer losing a large amount of money due to penitents not taking the medication properly. On the other hand insurance companies and disease management companies would also benefit on investing on medication reminders in order to prevent losing the large amount of money they lose due to the fact that many patients fail to take their medication properly. ALR TECNOLOGIES INC. reports that “The largest potential for sustainable long term growth and value generation lies with the market segments that have the most influence on the end-user and the most to gain from improved health results. These market segments are the health insurance providers and the disease management companies. The health insurance provider industry has the potential of reducing costs substantially through successful medication compliance programs. Industry data reports indicate that over $100 billion annually in health care costs are due to people not taking medications as directed” [3]

So hospitals, insurance companies and disease management companies would be interested in investing on medication reminder devices and/or systems in order to reduce losing money because of medications not been taken properly. And the patients themselves would be pleased to have a product or system to help them out of this challenge which causes in more health problems. Patients not only benefit from the health aspects of medication reminders, they also benefit financially because they don’t need to invest more money going to health centers because of failing to take their medications on time.

1.http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_a dherence.pdf 2. http://www.ageinplacetech.com/content/look-medication-reminders 3. http://biz.yahoo.com/e/060518/alrt.ob10ksb.html

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Ideas and Concepts Idea generation During the project two idea generations were performed. The first one was before the conversation with Huib Vader and the second was right after the conversation. During the first idea generation two mind maps were made. The first was about old people and the second about medication reminders. With these two mind maps insight was gained about the user and the market nowadays. The conclusion from these two mind maps is that there is not much space to do something completely new, because of the fact that this product must have a high reliability level. With this knowledge there was not much confidence in finding

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new ideas, but with the two mind maps it was possible to perform a brainstorm-technique. Each person had to combine two words from each mind map each and think as much ideas as possible. After that came a selection round which separated the reasonable ideas from the nonsense ideas and then all the reasonable ideas were grouped to get an overview of all the ideas and to figure out in what direction the product will head to.

The ideas did have potential, but they were not serious enough. This should become more serious during the project, but the overall conclusion was that the conversation with Huib Vader can give this project some direction.

Direct after the conversation the project had a direction. The group agreed in specializing the product to the thrombosis service. So a second brainstorm was performed. The technique called ‘Brain writing 6-3-1’ was used. Every team member had 20 minutes to think about 4 till 5 ideas. After that the sheet with ideas will be passed on so that another team member can work on the ideas of the other. Here are some explanations and pictures of the ideas that came out of the brainstorm: 1. Above a shelf, the schedule of the pill intake is projected or led’s are suggesting the schedule. When you put in the usb-stick with the INR information, the schedule will be projected automatically or the led’s will go on. Now the caretakers put the boxes similar to the projection and refill them so the caretaker can make fewer mistakes.

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2. As a feature we thought of a clip on the door handle. If the patient leaves the home he won’t be reminded anymore by the medication reminder at home. If they bring down the handle the clip will register that and send a signal to the other device and there will go of an alarm. The patient can choose to take the pill with him in the clip or if he is back on time, which he can check by entering the time he will be gone on the time bar.

3. A clock with the pills in the clock arms. The usb-stick in the clock sets the alarm. When the alarm goes off you have to push on a button and the pill will fall out like the ‘Smint’ way. After that the alarm goes out. 4. Pill bingo: Just playing bingo but then with pills. If you have your card full you have your schedule for your pill intake. Another idea with bingo is that the bulge spins when you have to take your pill. It will stop and the pill will fall out.

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5. Flowers that imitate your pill intake. If you take your pills at the right time your flower will stay nice but when you take your pills at the wrong time or you just forget them your flowers will wither. The pill that has to be taken is in the flower or leaf and will open when it has to be taken.

6. Bookcase: In every book on the case there is a pill. The book with the pill that has to be taken will move forward. You need to open the book to take the pill. This is the feedback for the device that you have actually taken the pill. The same idea can also be implement in a piano.

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A necklace that will vibrate as an alarm. When the necklace is closed you hear a weak alarm sound. When you open it the alarm gets louder, so wearing it is recommended.

An aquarium with fishes that imitate your pill intake. It is the same principal as the flowers. The fishes will say ‘blub blub’ as an alarm. When you take your pills at the right time the fishes will be alive and happy but when you are taking your pills at the wrong time or you forgot to take them, the fishes will die and there will come out a horrible smell.

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Choosing Concept After the idea generation there was a lot of choice in ideas. Two ideas were really striking. They fitted in the context of the project and the problem statement as the group formed it. It was the idea of the bookshelf and the clock. The bookshelf was not selected, because there wasn’t any need for the user to see a weekly schedule of the pill in-take. Another reason is that it would be a very modern looking device. It wouldn’t fit in the classic interior of the user. The clock gave us more space to integrate that. Further on the clock is a subtle way of a medication reminder; it is a familiar object that everyone has in his living room. It is a nice coincident that a clock is very time related just as the pill intake. The already existing products are working with boxes as pill dispensing system but that is something we specially want to do different. To give the impression that it looks different than the usual medication reminders is to make a clock of it. The pills are in the clock arms so no boxes are used and the pills are visible every time you look at the clock. The clock also does not have a sterilized look. An USB-stick has been integrated in the clock which registers the scheme for pill intake and sets the alarm every week. This is very reliable because it is excluding human errors. A negative point is that the clock is not portable, but a solution has been found: a clip on the door handle. If the patient leaves the home he won’t be reminded anymore by the medication reminder at home. If they bring down the handle the clip will register it and send a signal to the clock and there will go of an alarm. More information in Product Description.

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Final Concept

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Problem analysis of prototype Before making the prototype a small problem analysis was made. With this schedule it was possible to locate problems in advance.

Clock mechanism process

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As the decision was made on integrating the pill reminder with a clock with the pills in the clock hands, some research was done to find strong clocks which have enough power to move the clock hand that was designed as pill containers. But the wall clocks used indoors have light clock hands and they are not strong enough to move the designed clock hands and the clocks that did have the capacity to handle the hands were too big to use and this did not match our desire. The next step was thinking of empowering a clock by adding an extra engine to it. Below is a 3d model of a typical quartz clock mechanism.

Thinking about adding an electric engine to the engine existing in the clock, was one idea. Another idea was adding an engine by using an extra gear to

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make the clock stronger so it would tolerate the weight of clock hands we meant to add the clock. These ideas should be tested in real situations which would take long to test, but this wasn’t worthy for the prototype. The idea changed in making a simple but strong clock by ourselves by using two engines, one for the hour hand and one for the minute hand. The advantage of this is that it gives the strength needed for the designed hands and on the other hand the speed of the engines could be controlled as we desire to make the clock hands move in order to simulate a normal clock.

Product Description.

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According to the problem description, the product should be a really reliable piece of engineering with a usage in which nothing can go wrong. The product should be able to alert at any time, and what better way to do that than implement the reminding system in a clock. This heavy duty clock is the dispenser, as well as the organizer, as well as the reminder. The pills for thrombosis are placed in the (longest) clock arm which makes the system really integrated in the clock. The arms are see-threw so the patients and caretakers are able to see how many pills are left. These easy access clock arms can be refilled in a split second by just opening the arm from above and drop down the pills inside. The clock will alarm at the moment the pill has to be taken, and by pressing a button in the centre of the clock, a pill will be presented and the alarm will stop. If multiple pills have to be taken, the button has to be pushed multiple times to stop the alarm. The irregular medication schemes can directly be transported to the clock, using a USB-stick with the information and the results of the weekly blood test. The scheme will be converted into the alarm of the clock so human mistakes are executed. The clock is a usual object to have in your environment so its appearance stays on the background. But when taking a better look at it, it makes you realize it’s a pill dispenser due to the transparent clock arms with the pills inside.

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Prototype and Future Description

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In this description the prototype of the clock will be discussed and the problems and decisions faced are explicitly reported. Most decisions have something to do with material choices and the used techniques. The clock mechanism exists of two parts: A delayed DC motor which is directly connected to the inner (PVC) tube and a DC motor which is connected to the outer (PVC) tube with a gear on the edge. The DC motors are put on and off by using a power supply with voltage regulation to be able to let the clock arms turn round and show the working prototype at the exhibition. In the future a clock mechanism should be integrated which is powerful enough to support the heavy (and in weight changing) arms. This system could run on batteries which give a signal when they should get replaced, but even better, the system should directly be linked to the AC, providing a reliable power supply. This might be needed for the energy consuming motors, USB schemes and alarms. The clock arms itself are made from Plexiglas tubes with such a size that the pills are required to fit in it in one stand possible (which gives an advantage in dispensing them one by one). The dispensing system is integrated into the middle centre of the inner tube (on which the minute clock arm is attached with the pills inside). By pressing the button on the front, one pill will fall in a certain hole and because this button has a leaver at the back, pressing it will cause tension and the spring will force the slide bar to go back which makes the pill in the hole fall even further down and will be dispensed.

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This drawing shows the steps the dispensing mechanism goes through and how it’s working

A problem in the design and structure of the clock is that the mid engine supports both tubes and their clock arms. The outer tube is leaning on the mid engine and is held back by the upper engine. Because the button is at the longest tube its tip, pressing it gives lots of pressure on the support bracket. The solution made is a second bracket, in the shape of a half (hollow) ball which supports the outer tube (and with that, the inner tube) at its far end. It pushes the tubes up and reduces the pressure on the engine’s support pin.

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The bracket is made from a plastic material which breaks very easily when making adjustments to it. This isn’t a material which should be used in a final product but in this situation it was the best material for the job. Also in the future the support pin of the engine should be heavy duty and able to support a lot of weight. Another design problem in the current prototype is the spinning mechanism with inner electronics. The electronics from the button and the USB cable turn round in the system which isn’t ideal. In a final product all the technology can be much smaller which makes it easier to attach it to the USB and button switch and maybe even integrate everything into the inner tube. As an extra feature for the clock, it should be really great if patients and users also get reminded when leaving their homes. The proposer of this project thought it wasn’t necessary to make it portable because the users usually are home at the time the pill should be taken (six o’clock), but it would give the product an extra dimension of the patients were able to take it, or at least a part of it, with them. The idea was to make a ‘Clipper’. This clipper is a clicking system which can be attached on any door handle, because when a person is leaving the house he or she will always exit a door. This clipper will remind the person leaving the house, that he or she should take the pill(s) for that day (or more days, if they stay away longer) with them, and the pill(s) can be put into the clipper which the person will take with them. When it’s time to take a pill, the clipper will alarm the person again, which makes sure the person indeed takes it.

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Clipper:

Conclusion After extensive research and a very important conversation with Huib Vader it was able to make specially a product for the Thrombosis service. The product has the simplicity of only reacting on the alarm by the user and pushing one single button. This minimalizes the problem that the user can doubt about their pill intake and also that it is easy to understand. The look is a combination between a sterilized medication reminder and a normal clock, which makes it more familiar for them. For the caretaker it becomes easier because the schedule is automated. This prevents human errors in the process. The quick refill saves times, which might make it possible to have a nice conversation with the patient. A right treatment for Thrombosis is very important and this product aims at being highly sufficient and reliable in this treatment. It can be an improvement in the Thrombosis service and hopefully Thrombosis patients will get less dependent on this service one day.

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