Graduate Diploma Document by Rucha Patwardhan

NEW MEDIA INTERVENTIONS TO IMPROVE MEDICAL ADHERENCE

Rucha Patwardhan

New Media Design 2011-2013 National Institute of Design, India Guide: Shashank Mehta

index

DESIGN EXPLORATION

RESEARCH INTRODUCTION Acknowledgements Introduction for course About Honeywell, company Abstract of project Honeywell-outlook for project Why am I motivated to work for it Project Brief evolved for my outlook (tie Honeywell and my outlook together) Time line of project Company interest Portfolio in field and others(company research) Honeywell purpose defined Design purpose defined Insights grouping and Design Interventions

Field Exploration: Terms glossary Precedent Study Other companies Health care precedents Future study User segment research how other users deal with it why elderly only? Secondary research Research papers elderly related medication related design process related Understanding relationships Stakeholder roles Interview with stake holders Understanding problem from different angles Reflections and way forward Re-evaluate problem definitions

(how the problem is from various stakeholders point of view)

UNDERSTANDING THE ELDERLY Introduction: Population ageing Activities they indulge in technology acceptance in elderly what do they use? how much is enough? Group dynamics in elderly Family dynamics in elderly how families see the elderly Memories of significance Artifacts relevance in lives of elderly Medication outlook in elderly Pain points Places of intervention in their lives

Design goals Ideation categorization Ideation stages 1. Ideal solutions Design considerations Guidelines for designing for elderly 2. Filter and improve on ideas - Prototype ones with max solutions User feedback on prototypes Consolidate feedback 3. Improvise on solutions

CONCLUSION Present final solution Design point of view Analysis/synopsis solutions prototypes Honeywell point of view Analysis solutions marketing Image Credits References

ACKNOWLEDGEMENTS

ABSTRACT As a person grows older, the chances of having various ailments increases. As illnesses increase, physical and psychological changes happen too. New introductions such as medicines, treatments and lifestyle changes are also a part of growing old. Dependency on medications and constrains due to illness can make everyday life de motivating and discouraging. The patient might adhere to medicines over a short period of time, but what happens when it is for a life time. How can design interventions help patients adhere to long term medication schedules? This project tries to understand the need for design and technology intervention to help patients adhere to their medication schedule. The project aims towards making long term bulk medication easier to comply with. The project explores opportunities ranging from connectivity between people to organization skills of a patient. How can activities like taking medicines and visiting doctors, be a beacon for ‘‘getting better’’ rather than, ‘‘ a downward spiral in illness’’. Seamlessly integrating and accepting these medicines into their lives is the path undertaken in this project. Communication media for this project include visual communication, sensors and mobile interface. Project Blog: http://diplomaprojecthealthcare.wordpress.com/.

‘‘Compliance with intent...Not with words.’’ -Dave Cote, CEO and Chairman Honeywell

HONEYWELL OUTLOOK Honeywell being a product and engineering innovation company, looks at stable solutions that they can market over a period of time. This stability in their products ensures expertise in a particular solution that they design and they strive to offer the best solution in the market. Honeywell’s health care portfolio currently comprises of various digital remote monitoring, patient and doctor interfacing and some organising medicines solutions. The company interest lies in looking for new insights in the medication adherence market. These insights may be potential business opportunities for the company. According to their market study, the problem of medication adherence has tremendous potential for design interventions. Some of the broad level questions that they intend to gain insights into are: Which are the opportunities within the medication adherence loop in which Honeywell can introduce their technology? & How can this technology be introduced keeping in mind the human factors related to the user audience? They want to span the breadth of communication media, to see which combinations of design interventions have the potential to be taken forward as new business lines.

EVOLVED PROJECT OUTLOOK What are the areas of opportunity in medication management where design can intervene? What are the problems that the elderly in particular face in medication management?

MOTIVATION

How can we enhance the medical adherence interactions to make them more intuitive and engaging?

Before taking this project the author has worked on projects in the domain of visual communication through digital, print and motion graphics media. New media design projects have allowed these projects to be developed further into interactive art and interaction design projects. However, the ethnography and research domains have been left unexplored in these projects. Their remained a desire to work on a project which tied new media interventions and user centred research together. When this project was presented, it immediately caught the authorâ&#x20AC;&#x2122;s interest. The project presented an opportunity to tackle an user centred new media design project, along with comprehensive industry guidance from the Honeywell team. The health care domain posed an interesting challenge in front of the author. Such a serious issue, and with a different user segment, opened a large window of opportunity and risk. But, health care being one of the upcoming areas for design innovation opportunities and the authorâ&#x20AC;&#x2122;s interest to take up a challenging project, led to the author taking this project for Post Graduate Diploma. The author has interfaced with medical adherence problems very briefly, only while observing family members and reading. Exploring this problem on a deeper level and hoping to fully understand the entire ecosystem within which a patient lives that leads to medication noncompliance was the stepping stone to this project. Understanding and empathizing to a certain level would lead to seeing design opportunities in the given topic. This process of user research, transcribing and coding data, categorizing insights, and exploring design interventions was the main crux of learning in the project.

TIME LINE Registration

Jan Scope of Project

Feb

Mar

Apr

Secondary Research

May

Wire framing and prototype building

Analysis Primary Research Analysis

Concept Generation And validation 4

June

User Evaluation

July

Care provider systems:

These are remote monitoring systems which aim at improving the communication and transfer of information between different stakeholders.

COMPANY INTEREST Within the Health care domain, Honeywell is very active in the patient monitoring domain, the business unit is called, HomMed.They have advanced telehealth systems can be easily used where patients live, work and play allowing them to lead productive, uninterrupted lives. HomMed LifeStream solutions also provide clinicians with easy and efficient monitoring backed by excellent support and industry expertise. The result is better patient care along with improved clinical and financial outcomes. Some of their current products are given ahead.

LifeStream Manager was

MEDIUM:

Relationship: Hospital- Patient

Problem being addressed:Transparent communication of information between hospital and patient.

LifeStream Analytics

MEDIUM:

designed to improve patient care and management while streamlining clinical work flows.

makes it easier to deliver return on investment (ROI) information on the patientâ&#x20AC;&#x2122;s telehealth program. Relationship: Hospital- Patient- Financer

Digital Screen: Computer

SHORT COMINGS:

Restricted to screen Difficult to understand interface

SHORT COMINGS:

Restricted to screen Difficult to understand interface

Problem being addressed: Difficult to judge which medication treatment suits the requirements of the patient(health wise and financially)

PATIENT DEVICES LifeStream Connect

allows the patient to integrate his/ her Electronic health and medical records with most other point of care applications.

MEDIUM: Digital Screen: Computer

makes it easy for healthcare providers, families and patients to track patient health anytime, anywhere. Relationship: Patient- Doctor- Family

Restricted to screen Difficult to understand interface

GENESIS DM Problem being addressed: Integration of hospital data and patient reports

Relationship: Hospital- Patient

LifeStream View

SHORT COMINGS:

These are monitoring systems within the userâ&#x20AC;&#x2122;s household. They connect with other devices like the BP monitors, weighing scales, diabetes monitors to collect information at one place and then communicate to the health care provider.

MEDIUM: Digital Screen: Computer

SHORT COMINGS:

Restricted to screen Difficult to understand interface Interface does not customize for each stakeholders specific needs

Problem being addressed: Access to information from all platforms for different stake holders.

Consists of dependable health symptoms assessments based on the delivery of clear auditory and visual cues. Voice-enabled, disease-specific symptom management (DSSM) questions (including multi- level selections, where if the patient provides a Yes answer to the initial question a follow-on question will be triggered) provide symptom-specific tools, and a full array of disease management reminders and care provider selectable questions/education to improve the management of a broad number of patient populations including: hypertension, COPD, CHF, diabetic and other chronic disease patients.

Flexible patient installation and operations:

Automatic Set-up Wizard allows users to easily adjust monitor settings. Comprehensive user interface for quick, easy set-up at the patient site. Web-enabled for automatic downloads of patient specific disease management content, updates and prompts. Works seamlessly without a land line connection. Wireless GPRS communications provides enhanced cellular connectivity, simple setup and improves content download speeds. Robust security for enhanced peace of mind Protects private health information via industry-proven encryption to ensure that patientidentifiable data is not stored on the device or transmitted. The factory default reset function allows the monitor to be re-set and transferred to other users.

End to end patient care: The products in this segment are very functional and detailed, no doubt. But they lack the personal touch or experience.

Patient specific messages and reminders help patients keep track of medical appointments and other important events.

Enhancing this experience can help communicate the information in a better and more sensitive manner. Customizing information to the needs of each stakeholder is another requirement that needs to be addressed. Quick and to the point information can help increase productivity. 8

LIFESTREAM MOBILE DEVICES By providing people with an around the clock sense of security, Honeywell HomMed’s Mobile Personal Emergency Response System (mPERS) increases the user’s peace of mind, regardless of whether they are in their home or out and about.

GENESIS TOUCH Genesis Touch is a remote patient monitoring device that significantly steps up the level and quality of care by increasing the flexibility and ease of use. It collects biometrics and transmits them to Honeywell’s LifeStream Management Suite. And with its simplified connectivity options, flexible operations and intuitive user interface, the Genesis Touch is a more convenient and comfortable way for patients to stay connected to their caregivers.

Improve Patient Interaction via Integrated Video Application:

Simple, integrated video application – Improves patient oversight by providing face-to-face contact, lowering the cost to interact with hard to access patients. Multi-user collaboration – Increase visibility to patient health status, facilitating improving care giver and physician involvement by enabling multiple video participants to be invited to join. Improve educational effectiveness by creating a more interactive environment through easy call recording and playback Cost-effective (optional) licensing structure simplifies video license management for patients and facilitates broad video adoption

At the same time, Honeywell HomMed can offer care providers a more comprehensive picture of a patient, such as the ability to view all LifeStream MobileHelp call details, including 911 calls, within LifeStream, thereby improving the lives of users and assisting their care givers. Combined with LifeStream, it provides the industry’s first integration of telecare and telehealth data, simplifying care coordination and work flows for the care provider. Most importantly, the integrated cellular and global positioning system (GPS) location services enable a more active lifestyle by allowing care providers to locate users wherever they request assistance. Users can break the tethers of a traditional land line solution because improved oversight gives users the confidence to leave their homes and be as mobile as they want or need to be.

Need to integrate these devices so as to help the patient from all sides. The interactions with these devices is not uniform. Hence they have an independent learning curve for each one.

PROJECT PURPOSE DEFINITION Honeywell Point of View Honeywell wants to expand their health care business and thus, the people there are now looking for new insights into this market. These insights may be potential business opportunities for the company. To move into a new domain within health care, they see medication adherence as a big problem, which has tremendous potential for digital interventions.

What are the opportunities within the medication adherence loop in which Honeywell can introduce their technology? & How can this technology be introduced keeping in mind the human factors related to the user audience?

USER SEGMENTS

PRECEDENT STUDY

The problem of medical nonadherence affects people of all age groups and economic strata. Narrowing down on a segment was needed.

What is the process that elderly need to undergo in medication management? To understand the process of medication, a thorough breakdown of the entire process was done. This helped understand the roles of the various stake holders within the medication system and their interactions with each other.

WHY ELDERLY? Medical adherence in the elderly posed a very interesting challenge. They are individuals who have lived their life in good health and pride. With an ageing body, they need to start depending on medications and doctors. At a stage when they can do as they please, ill health forces them to make changes in their lifestyle. Age old habits need to be altered. As their health problem and dependency increases, they start to feel like a burden to people around them. Unfortunately, their children are so busy in their own lives that neglect and lack of attention can lead to building psychological problems. Over all these increasing changes, helping them accept and manage their medications easily is a challenge. This project tries to tackle this problem.

DOCTOR- PATIEN

Record of treatment/ Prescription - explain to patient and help them understand - unambiguous and communicate enough information on intake of meds

DATA COLLECTION (REPORTING AND AUDIT), REVIEW OF QUALITY AND SAFETY, SYSTEM IMPROVEMENT

INDENTIFICATION OF ILLNESS

Issue of medicine

REVIEW/toRECHECK Patient feels symptoms and communicates family Family takes him to the doctor - check if patietn has understood the meds schedule

- understand if the intent and expected outcome of the medication is clear to all - optimize the use of the meds - devise patient-friendly schedule which is easy to adhere to - consider all side effects according to patient MEDICINES PROCUREMENT AND MATERIALS MANAGEMENT - all meds are checked to eliminate side effects Decision on Treatment (prescribed/ OTC/ short term/ life long) Type of treatment - consultation with doctor and patient - understand the consumers treatment goals - medical history of patient - cost effective(consult with patient and insurance) Record of treatment/ Prescription - explain to patient and help them understand - unambiguous and communicate enough information on intake of meds REVIEW/ RECHECK - check if patietn has understood the meds schedule - understand if the intent and expected outcome of the medication is clear to all - optimize the use of the meds - devise patient-friendly schedule which is easy to adhere to - consider all side effects according to patient - all meds are checked to eliminate side effects (prescribed/ OTC/ short term/ life long)

- processing , dispensing and supply of meds - record of the medicine being issued - complete info about the med should be provided to the patient - if additional info is equired by the patient it should be easily available -storage of meds and usage - medication safety and quality and quantity of meds should be communicated EFFECTIVE COMMUNICATION OF ACCURATE, COMPLETE AND COMPREHENSIVE INFO

DOCTOR- PATIENT

PATIENT DOCTOR- PATIENT

- cost effective(consult with patient and insurance)

Administration of meds - reassessing the med intake and schedule - check if the med is taken at the appropriate times, in correct dosage and in enviroment Monitoring of meds - record of administration of meds - time, which meds, time of intake, times missed -evidence of symptoms of side effects -monitoring improvement and need for re-assessment of meds Transfer of medical information/ anywhere access of medical information - actual use of medicine to impact of med on patient - communicating the patient history and current state of medication - effects and preventions of different meds - future path of medication - description of changes to therapy

MEDICATION ACTION PLAN:

- if meds are over, then refill notification should be issued - if the course of the meds is over then issuer and patient should be notified - regular check ups and change of medication needs to be recorded

MEDICATION ACTION PLAN:

- the administration of medications should change if notified so by the issuer - the medium of dispensing(box) should be updated accordingly.

REFILL AND REASSESSMENT OF MEDICATION

ELECTRONIC COMMUNICATION OF DOCUMENTS

Issuing of meds -regular appointment and vitals check up needs to be initiated - infomation about med schedule adherence should be available at all times

INFORMATION REQUIRED FOR EACH MEDICINE: MONITORING REQUIRED FOR EACH MEDICINE:

MONITORING

-consumer identification and general information - a list of all current medicines, noting those recently ceased or not being taken - risk assessment (e.g. adverse medicine events, allergies, visual impairment and administration aids) - action plan (e.g. description of the problem (issues), goals of therapy, action to be taken to achieve goals, person responsible for action, date for completion) - documentation of the concordance discussion with the consumer and relevant discussions with other health care providers - communication details (e.g. who and where the Medication Action Plan was sent to and whether referral was recommended).

INTERMIDIATE MONITORING

PHARMACIST-PATIENT

A Medication Action Plan could include:

Information required on cover areas: - active ingredient and brand names - purpose and action - dose, route and administration schedule - special instructions about missed doses - special directions and precautions -side effect symptoms

Information required on cover areas: - routine revision - change in dosage update - number of missed/taken doses/ refill alert - adhered the directions/ emergency - time to time questions to identify symptom -tests for monitoring progress/change in meds

-patient needs to be communicated the effect of his non-adherence on his health Refilling of meds - if meds are over, then refill notification should be issued - if the course of the meds is over then issuer and patient should be notified - regular check ups and change of medication needs to be recorded - the administration of medications should change if notified so by the issuer - the medium of dispensing(box) should be updated accordingly.

The health care continuum can be viewed as a series of cycles. Each cycle relates to an episode of care. For each episode of care, there is a corresponding medication management cycle, which comprises the nine key components listed below. The characteristics of each component depend on the health care setting involved and the nature of the episode of care. This document focuses on those components of the medication management cycle that are critical to achieving continuity in the medication management continuum.

The main factors that emerge in medication management are: 1. Communicating information/ data effectively 2. Tablet transactions 3. Feedback/ monitoring loop

TABLET TRANSACTIONS

PRECEDENT STUDY There are many solutions which have been designed to tackle medical adherence from various angles and levels. To learn more about the already existing solutions, various precedents were studied. These were classified based on the main factor they contributed towards handling.

TABLET TRANSACTIONS

COMMUNICATING DATA/INFORMATION EFFECTIVELY VOCERA

WIRELESS COMMUNICATION SYSTEM Mobile application and gadget worn in neck

TABLET TRANSACTIONS

Patient is admitted and the nurse/doctor is assigned to the patient.

Patient is resting in room, when he/she faces an emergencyâ&#x20AC;ŚClicks button on bed button or a voice command is initiated

Nurse/doctor neck gets an alert through the neck tag.

The nurse uses the voice command system and calls the doctor through the neck tag and remains with the patient itself.

Doctor gets alert on his vocera device and rushes to the patient room Mobile application allows doctors/nurses and family members to access data remotely through a mobile application. Saves time between realising situation--->understanding need--->chaos creation ---->finding the doctor---->doctor understanding need of patient and prioritizing----> nurse/doctor coming to the patient Easy to carry and is always with nurse. Thus it helps facilitate communication.

Multi platform interactions are required when designing for the elderly. Each solution aims at simplifying one aspect of organising. Which one of these approaches will best suit an elderlyâ&#x20AC;&#x2122;s needs? This everyday task needs to be made more interactive and intuitive to keep the patient interest going. At the same time it needs to gel into the lifestyle. It should be a part of the lifestyle.

Family bonding Have them interview you on video. Share a favorite memory, Build a family tree, Share a special talent with them. Make a lunch date. Scrapbook together, Listen. Let them know they are loved and appreciated.

FEEDBACK/MONITORING LOOP

FEEDBACK/MONITORING LOOP SqueeView

INVOLVE social circles

- old memories with recalling

Collective Discovery

Improve connectivity and contribution from people who care.

Family album +phone Discovering cures in 'everyday experiments'. calls

ENeighbor

Connecting OLD refe

Enhancing the visual and spatial cognition of the elderly http://ceur-ws.org/Vol-955/papers/paper_47.pdf

Brainstorm and gain collective inputs to change the way aid is provided

Connect-care in

- old print contact Caregiver and elderly, list ques GAMIFY

Track the elders motion around the house and autmatically detet any fall or harmful siuation

Physical Treatment and Gamification

Show the physical exercise fun game, Share stories relatedlike to anaobject/picture to increasehttp://waag.org/en/project/express-connect involvement.

JitterBug Oovit PT

Making physical therapy fun and effective

Worry: My parents won't be able to reach me in an emergency

31 Online combined games with family and grandchildren

health monitoring system

Share stories related to an object/picture http://waag.org/en/project/express-connect

JitterBug Worry: My parents won't be able to reach me in an emergency

FEEDBACK/MONITORING LOOP Online combined games with family and grandchildren

FEEDBACK/MONITORING LOOP Connecting OLD reference and NEW:

INVOLVE social circles

nition of the elderly per_47.pdf

Use of ENHANCED feedback loop.

Improve connectivity and contribution from people who care.

ENeighbor

-Ex: Report delivery in a diabetic patient coupled with a positive encouragement video from doc

Connect-care innovations Caregiver and elderly, question based health monitoring system

- old memories with new ways of recalling

Family album +phone calls

Iâ&#x20AC;&#x2122;m Listening

Track the elders motion around the house and autmatically detet any fall or harmful siuation

- old print contact list with new tech Share stories related to an object/picture http://waag.org/en/project/express-connect

JitterBug Worry: My parents won't be able to reach me in an emergency

Collabo-Rhythm Encouraaging reports and mediator

Online combined games with family and grandchildren

Each precedent studied addressed the needs of a specific group/individual of stake holders. The study helped understand what each one of them required from a medication management solution.

Patient Requirements

Pharmacist Requirements

1. Least Effort 2. Motivation 3. Information about medicine timings 4. Efficient + easy to operate 5. Easy to open pill box 6. Simple -Simplifying regimen characteristics; - Imparting knowledge - Modifying patient beliefs - Patient communication - Leaving the bias - Evaluating adherence

1. Easy to fill 2. Remote Monitoring 3. Correct communication of medicines to patient 4. Design medicine plan (less frequency of taking meds) 5. Therapy side effects monitoring

Doctor Requirements 1. Cost effective compared to the medicines 2. Patient gets well and does not relapse

SECONDARY RESEARCH RESEARCH PAPERS ELDERLY BASED Understanding of the domain and exploring the problems faced within it was the first step. Reading research papers, blogs and various health care write ups helped explore the learning further. Summaries of the important papers and learning that helped progress has been given ahead.

But these requirements were too broad. What does each one actually need to tackle and what do the elderly actually need to help them adhere? TO know more about these factors a more in depth study was needed.

Source: U.S. Pharmacist, A Jobson Publication Published by: Katherine L.Vogel Anderson, PharmD University of Florida College of Pharmacy The research paper describes adherence to a medication regimen as “the extent to which patients take medications as prescribed by their health care providers.” Many factors contribute to nonadherence, including cognitive impairment, medication side effects, the regimen’s complexity, and the patient’s scepticism about the benefits of the treatment. Compliance to taking medications in the geriatric population is even less due to added physical and psychological problems they face. As the patients grow older, there is an increase in their health issues and thus the medications. Common ailment groups lead to continuously increasing number of medicines. Example: Diabetes coupled with blood pressure and hypertension. This can lead to confusion in taking medicines, lack of knowledge, forgetfulness and medical nonadherence. Taking so many medications and facing health issues (additional number of side effects) also works negatively on the mind-set of the person. Psychological demotivation is an additional reason for the increase in medical nonadherence. Limitations such as difficulty in opening child safe medical pill boxes can also add to nonadherence.

Source: Senior-Friendly Technologies: Interaction Design for Senior Users The elderly represent a valid group of users who can potentially benefit greatly from engaging with technology, such as health care systems or playing digital games. Yet, less attention has been given to the significance of senior citizens as technology users, as compared to the common younger population. In an effort to fill in the gap, this workshop aims to investigate the design of technology for senior citizens. Senior citizens represent a growing base of users that can potentially benefit from an engagement with technology such as mobile phone games. The aim of this paper is to discuss about challenges faced while designing technology for the senior audience by understanding how the design process can be adapted effectively, leading to an exploration of considerations and requirements for proper future targeted design and research work.

Assessment of the barriers for each patient in medication adherence needs to be analysed by the pharmacist before prescribing the tablets. A very simple medication schedule needs to be planned for the elderly which will decrease the pill burden. Psychologically they should not feel bogged down by the number of medications. Involving families in the loop, thus ensuring sufficient support for the patient can help in motivating them. This also has a down side as excessive interference from care givers can lead to a feeling of dependency in the patient’s mind.

The ecosystem around the elderly needs to allow him a certain degree of independence, but at the same time keep track of the patients medication activities. To strike a balance in the two is important. Psychological motivation emerged as an important factor in helping the elderly.

Questions that developed: 1. What kinds of technologies are relevant for the elderly to use? 2. What design issues are pertinent when designing for a senior audience? 3. How can the contexts and needs of the elderly influence interaction design for them? 4. What methods and techniques should be used to design technology for older users? 5. What factors motivate the use and acceptance of technology among the elderly population? 37

Source: Home Medication Management for the elderly

A research paper on elderly and their lifestyle gave some very useful insights on how elderly manage their medications at home. Some of the insights gained have been mapped below.

OTHER RESEARCH PAPERS REFERRED TO http://www.who.int/chp/knowledge/publications/adherence_introduction.pdf TO BE ADDED

A set of potential problem in each stakeholder relationship started emerging from the research papers.

What was still unclear was which one of these really affected the elderly? How did they tackle these issues in their daily lives? What were their needs and where could design help solve their issues simply yet effectively? What did enhancing the medication management experience mean to them? Gaining a perspective on the requirements identified from the elderly was the next step in the process. To know more about these points, user interviews with different stakeholders was conducted.

Type of doctor: family, specialist, same doctor, multiple, home doctors 1. Do you review the patient history when you are administering the meds?

1. Do you have any life long illness? Have you had any additional illness? 2. How do you feel about people knowing that you have a life long illness? 3. How many medicines do you have in a day? 4. Which of these are tablets- syrups- injections? 5. Where do you store these medicines? What is your medication schedule?

Patient discussion guide Points to be covered: a. Information about patient history b. Medicine details- when to take, why to take c. Organizing meds d. Side effects e. How techno-savvy are they f. Side effects and symptoms info g. Technology interference or help?/ Steals away independence or is seen as a boon

6. Do you have a list of medicines? Can you give me some details for each? Why do you take them? For which illness is which one? How do you remember the medicines?

Pharmacist discussion guide

2. Do you help in the refill of medications?

Points to be covered: a. Patient history and side effects for certain meds b. Patient and medicine tracking c. Refill requirement d. Patient policy e. Accountability? How involved is the pharmacy in the doctor- patient loop

3. How do you keep a track of patient medications? Do you have a monitoring system for this? 4. When you administer a medicine, do you know which medicines the person takes already? How do you keep a track of side effects of different medicine? 5. How many people do you need to refill meds? Is it a monthly/ weekly or 3 monthly refill system?

7. Why do you take medicines? Which ones are easier to take? 8. Do you get help while taking medicines? / How independent are you in your medication management? 9. If you had to choose five medicines out of all these that you would like to take, which one would it be and why? 10. How many meds are you comfortable taking? When is it easier to take meds (what time of the day?) 11. How often do these medicines change? How do you go about while changing the meds? 12. Who sorts out the old ones from the new? Who makes sure all the new meds are in place? 13. Where and how do you get the medicines? Pharmacies, nearby shop go and get, call and order?

Caregiver discussion guide Points to be covered: a. Understand the way the elderly react when spoken to about their medical issues b. How much do you interfere c. Ways of keeping int touch with elderly d. Understanding symptoms e. Refill timings f. Medicine intake accountability

VOICE OF CONSUMER

TRIVENI

AFFILIATED ORGANISATION

AGE

LIFESTYLE

Not very active

HEALTH ISSUES

High Blood Pressure Cataract Vertigo

Central Government Health Services

HANDLING DOCUMENTS

Keeps diary of appointment and files from each hospital/clinic for all her medical tests; has a big bag of all the files. Has to carry all of them whenever she visits a doctor

1. Identifies strips by colour and shape If two strips look similar, she CAN’T figure it out. After removing from blister pack, gets confused between pills, all look similar

REMINDER SYSTEM

Uses daily activities to remember. Ex: after cooking dinner, after TV sitcom

CAREGIVER

Handles all the meds herself, her husband and her go together for all hospital visits

2. Can’t read English, is dependent on her husband to read pill names 3. Seemed worried about her health, tensed about recent cataract operation and new medicines

METHOD OF REFILL Has a file from CGHS, which has all his medical needs. CGHS gives him medicines enough for every month, he goes every month and refills them.

MEDICINE SCHEDULE

RAGHUNATH AGE

LIFESTYLE

Retired, stays at home, has friends in the pension groups whose programs and get-togethers he attends

HEALTH ISSUES

High Blood Pressure Diabetes Type2 Prostate issues Heart ailments

Has three pill boxes for prescriptions MORNING, AFTERNOON, NIGHT. Supplements and other pills are kept separately. Pills are kept in strips, with extras also in the same box. 1. REMEMBERS meds according to colour of strip. 2. Colour of medicine strips often changes 3. If he forgets, he has to refer to the PRINTED PRESCRIPTION GIVEN BY CGHS DOCTOR

HANDLING DOCUMENTS

Has a diary for appointments, a file for all prescriptions and files from each private hospital for other tests conducted. HAS A LOT OF PAPER DOCUMENTATION in a big bag

METHOD OF REFILL Has a file from CGHS, which has all his medical needs. CGHS gives him medicines enough for every month, he goes every month and refills them.

REMINDER SYSTEM

Uses his phone alarm to as reminders. Gets confused between wake up alarm and medicine alarm.

AFFILIATED ORGANISATION Central Government Health Services

CAREGIVER

1. Medical treatment is covered by CGHS Free of charge medicine, takes medicine prescribed by doctor more seriously than supplements

Handles all his meds on his own, and gets help and nagging from his wife

2. divides task of taking medicine: -removes each set of meds in small box a while before actual taking time -gulps them all in one go

MEDICINE SCHEDULE

3. Knows which medicine is for what from prescription, has to access everytime. Recognizes meds through: colour and shape of tablet and strip (The packaging of some tablets change frequently) 4. Lot of paperwork from each clinic/hospital, carries it every time. Keeps adding new medicines. Does not bother much about old medicines being wasted. (Supplements, vitamins..) 5. throws away the previous batch, if anything is left (therefore no one knows how many he has actually taken) 48

RANGESA AGE LIFESTYLE

HEALTH ISSUES

PILL BOX 53 Gets up at 5, has breakfast in the house, carries tiffin for lunch and snacks which is prepared by wife, leaves home and travels to office. Has a hectic working day and returns home by 6 30, has dinner, sleeps.

At the beginning of every month, Meera cuts all the strips into separate pills and places them into the compartments. The compartments are numbers 1-->30(for each day of the month).

HANDLING DOCUMENTS

Keeps files from all the hospitals and clinics, categorised according to medical condition

To remember to take the medicine, Rangesa breaks one of the meds in half. He has one half in the morning and the other in the night. THIS IS AN INDICATOR TO MEERA THAT THE REQUIRED MEDS HAVE BEEN TAKEN.

METHOD OF REFILL Wife(Meera) keeps a track of all his medications. When they are over she orders the needed ones from the pharmacy along with extras. She keeps track of the meds, refills the pill box systematically at the beginning of every month. If new meds are added in the middle of the month, she has to change the entire box.

MEDICINE SCHEDULE

High Blood Pressure Diabetes Type2 Hyper Tension

CAREGIVER

Meera, handles all his medications, packs extra medicines when he is going to travel and keeps a track of medicines in the box to make sure he has all his medicines. She is very involved in his medications and this makes him feel that she â&#x20AC;&#x2DC;nagsâ&#x20AC;&#x2122; too much.

REMINDER SYSTEM Remembers pills when wife reminds. Also associates each dose timing with meal timing. Often forgets if in meeting. Does not like to set mobile reminders as they might disturb him during his work hours.

1. Has a person to look after, caregiver(wife). As less effort is put in by him to manage medications, he is not motivated enough to take medicines on his own. Waits for wife to call or remind him. 2. Meds integrated into lifestyle by caregiver(places of keeping, cut and kept, near bed stand) 50

NARAYAN RAO AGE LIFESTYLE

HANDLING DOCUMENTS

Keeps files from all the hospitals and clinics, categorised according to medical condition

CAREGIVER

Does not need much assistance in everyday meds, gets help from daughter in law

Quite inactive. Mostly at home, reads the newspaper, has lunch at 12, sits in the sun and reads, goes to sleep, sits outside in the terrace. Very prompt and systematic

METHOD OF REFILL When he sees the packet getting empty, he tells his daughter-in-law.

Generally replenishes every month

REMINDER SYSTEM HEALTH ISSUES

Remembers as per meal timing. Also associates with prayer timing.

Parkinsons Asthama

MEDICINE SCHEDULE

1. Has lesser number of medicines, which are easier to handle for him 2. Source of motivation: disciplined lifestyle and family 3. Placement of medicines in according to his lifestyle. Ex: Medicine before bed time is kept under pillow.

VIJETA AGE LIFESTYLE

HEALTH ISSUES

MEDICINE SCHEDULE 76 Very simple lifestyle. Stays at home mostly due to old age. Walks with a stick, bent due to age, has knee problems, gets tired faster due to asthma

High Blood Pressure Asthma Knee Pain Fainting Problems Hyper Tension

HANDLING DOCUMENTS

Keeps files from all the hospitals and clinics, categorised according to medical condition

REMINDER SYSTEM

Has set mobile alarm, but cannot hear it often as she does not carry her phone around all the time. Depends on memory and often takes late doses as she sees the alarm later.

CAREGIVER

Does not like being reminded, has daughter to look after her. But does not like anybody interfering.

METHOD OF REFILL She forgets to remind very often but does not like to admit it. A few days after the meds are over she realises and then tells her daughter, who orders the required meds for the next month from the pharmacy.

1. Has more medicines, therefore less adherence due to confusion 2. Independence is important to her. Does NOT like being reminded 3. Takes medicines only when she feels ill. Leaves them as soon as she feels a little better 4. No schedule, medicines not kept properly. Finds it difficult to keep a track of them 55

WAYS OF ORGANISING MEDICINES

ACTIVITIES DURING THE DAY

STUDYING THE PATIENT To understand the overall lifestyle of the patients interviewed, all the information obtained from each one was charted on brainstorm sheets. This helped get a holistic idea of the way the elderly currently managed their medications and lifestyle. FAMILY

RESPONSIBILITIES & COMPANION

HOW EACH METHOD INTEGRATES WITHIN THE ELDERâ&#x20AC;&#x2122;S LIFESTYLE STORING MEDICINES & RELATED INFORMATION

RECALL VALUE FOR MEDICINES

DRAWBACKS: 1. lack of disciplined organization of medicines 2. no way to track which medicines are left 3. unreliable visual cues to identify medicines 4. disconnect between the schedule imposed by pharmacist and the lifestyle of the elderly 5. No one monitors medicine intake, hence no idea if the patient is taking 59the medicine or not

COMMUNICATION: 1. Nobody to ask doubts about medication to. Has to wait till next doctorâ&#x20AC;&#x2122;s appointment 2. Family/ children have no idea what medicines he takes or if he takes them on time 3. Feel left out & lacks attention from family members REMINDERS: 1. Nobody to remind, wife asks occasionally 2. Mobile alarms do not help as he snoozes them off. Gets confused between a wake up alarm and medicine alarm 3. Gets disturbed with alarms during his sleep/watching TV/ talking on the phone 60

Apart from the medication process, the environment and interactions that the elderly have in their everyday life affects their well being in many ways. Understanding the peripheral factors that affect the elderly was required to fully understand their requirements. 61

COMMON PAIN POINTS THAT EMERGED FROM USER SCENARIOS

1 Cannot grasp all the information given during the doctorâ&#x20AC;&#x2122;s appointment.

2 To verify medicine names and times, the prescription needs to be accessed every time.

3 2

3 Alarms disturb ongoing routine, can be easily snoozed or ignored. If the userâ&#x20AC;&#x2122;s phone is away they are often not heard.

4 If all the information is shared with others, the elder fear for invasion of privacy. They also have concerns regarding the safety of their information.

5 To take the medicine, the patient has to handle too many artefacts (specs, prescription, tablet strips, water)

6 62

When new schedule comes in, the patient has to manually reset all the alarms.

COMMON SCENARIOS THAT EMERGED FROM USER INTERVIEWS

Cannot grasp all the information given during the doctorâ&#x20AC;&#x2122;s appointment.

2 To verify medicine names and times, the prescription needs to be accessed every time.

Alarms disturb ongoing routine, can be easily snoozed or ignored. If the userâ&#x20AC;&#x2122;s phone is away they are often not heard.

If all the information is shared with others, the elder fear for invasion of privacy. They also have concerns regarding the safety of their information.

5 To take the medicine, the patient has to handle too many artefacts (specs, prescription, tablet strips, water)

6 When new schedule comes in, the patient has to manually reset all the alarms. 64

COMMON SCENARIOS THAT EMERGED FROM USER INTERVIEWS

ACTIVITY ANALYSIS WHAT IS THE ACTIVITY?

What motivates them to get better?

ACCESSING THE CORRECT MEDICINE, TAKING THE CORRECT DOSE

WHAT ARE THE STEPS INVOLVED CURRENTLY KNOWS IT TIME TO TAKE MEDICINE

What do they aspire to do?

What joy points are they looking to achieve after getting well?

User gets an alarm

How can integration of medications into the lives of the elderly be smooth so as to not impose too much change

What makes the life of an elderly ‘good’ OR performs an activity

OR sees the time that helps him know its time to take medicine

Live a good life according & do as please

GOES TO GET MEDICINE BOX How can the getting better experience be enhanced?

FINDS EYEGLASSES TO READ SITS AT ONE PLACE OPENS BOX MEDICINE SCHEDULE

The patient accesses the prescription to know schedule.

OR Uses memory and recall value to OR has schedule written on box take out medicine

Get well sooner

TAKES OUT STRIPS/PILLS CLOSES BOX GOES TO TAKE WATER

Take correct medicine on time

HAS MEDICINES

ARTEFACTS

Mobile phone Alarm clock Medicine Schedule

Spectacles

Prescription Pill Box Pill Strips Scissors

Glass Water

GOAL Take correct medicine on time

Get well sooner

Live a good life according & do as please 68

Zooming out and looking at the medication process from a broader perspective was used to understand the relevance of medication in the life of the elderly. The macro level objectives played an important role in understanding how to enhance and improve the medication process for the elderly. 69

ACTIVITY ANALYSIS WHAT IS THE ACTIVITY?

REMINDER ALARM FOR ‘TIME TO TAKE MEDICINE’

WHAT ARE THE STEPS INVOLVED CURRENTLY

What do they aspire to do?

USER GETS AN ALARM ON HIS PHONE THE USER IGNORES THE ALARM

Take the medicine

The user walks up to the phone

SNOOZES THE ALARM

How can alarms be used to motivate the elder? What motivates them to get better?

THE ALARM RINGS AGAIN SWITCHES OFF THE ALARM

Motivate to take medicines

GOES TO THE PILL BOX

How do the elderly perceive alarms

TAKES OUT STRIPS/PILLS

How can reminders be integrated into the lives of the elderly?

CLOSES BOX GOES TO TAKE WATER Hear and identify the reminder

HAS MEDICINES KEEPS PHONE IN IT’S PLACE

ARTEFACTS

Mobile phone Alarm clock Medicine Schedule

Prescription Pill Box Pill Strips

GOAL Hear & identify the reminder

Motivate to take medicines

Take the medicine 70

Reminding the elderly to take medicines is the first task necessary for them to take their medicines on time. Making the reminder system elderly friendly can help ensure medical adherence. 71

understanding the

EELDERLY EL L So who are the elderly? How are they different from the younger generations? What is their impact on today and the future? These are some of the questions that needed to be answered. The worldâ&#x20AC;&#x2122;s population is growing older, leading us into uncharted demographic waters. There will be higher absolute numbers of elderly people, a larger share of elderly, longer healthy life expectancies, and relatively fewer numbers of working-age people. There are alarmist views â&#x20AC;&#x201C; both popular and serious â&#x20AC;&#x201C; in circulation regarding what these changes might mean for business and economic performance. But the effects of population aging are not straightforward to predict. Population aging does raise some formidable and fundamentally new challenges, but they are not insurmountable. These changes also bring some new opportunities, because people have longer, healthier lives, resulting in extended working years, and different capacities and needs. The key is adaptation on all levels: individual, organisational, and societal. A recent report reveals that the global population of the older people is growing at its fastest rate ever. The United Nations Population division predicts that the population aged over 60 will increase by more than 50% over the next four decades. An older population will precipitate the need for better health care.

POPULATION SHARE

1990

2030

LIFE EXPECTANCY

65 67 Years

Medical Non-adherence & Elderly An estimated 33 to 50% of patients do not adhere to their medication regimens as prescribed. In a study aimed at adherence in the elderly population, it was demonstrated that when prescribed stating therapy, there was only 40% compliance. Also, the highest rate of nonadherence tends to occur within the first few months of therapy. Explanations include the sudden added financial burden of a new prescription or the appearance of side effects soon after initiation. The elderly also face additional problems such as loneliness, detachment, sudden void, dependence on medication, and the diminishing motivation to get well. This can be further fuelled by lack of care and attention from the family. As the person ages his health problems and medications can increase. This turmoil between knowing that the medicines are meant to improve health and feeling a sense of dependency on the medicine can lead to additional nonadherence. Among this group, the medication they take can be divided into short term medications (acute medications) and chronic illness medications (maintenance medications). The short term medication has a higher chance of adherence from the patient. Reason for this can vary. Example: the patient has just gotten out of the hospital, he thus knows the severity of his ailment, also his family will pay closer attention to him as he is still recovering. Short term medication thus has a slightly higher chance of adherence. Long term medication for chronic illnesses are something that need to be taken for a lifetime. These need to become a part of the lifestyle of the patient.

Example: Complexity of regimen; side effects

AS LISTED BY WHO

PATIENT DISABILITIES

SOCIOECONOMIC

THERAPY

Example: Low literacy; higher medication costs; poor social support

Example: Physical impairments (e.g., vision problems or impaired dexterity); cognitive impairment; psychological/behavioral; age

HEALTH SYSTEM

MEDICAL CONDITION

Example: Poor quality of provider-patient relationship; poor communication; lack of access to health care; lack of continuity of care

Example: Asymptomatic chronic disease (lack of physical cues); mental health disorders (E.g., depression)

Medication nonadherence may occur at different points in a patientâ&#x20AC;&#x2122;s decision-making process. It may occur at the start of therapy if a patient receives the initial prescription but does not fill it (primary nonadherence), or it may occur after therapy has started if the patient fails to follow the instructions or fails to refill the prescription (secondary nonadherence).

Primary Non Adherence Falling Ill

Visiting Doctor

Secondary Non Adherence Get Prescription

Purchasing medicines

Organizing medicines

Taking medicines

Revisiting medicines

To understand the elderly audience better, brainstorming on different facets of their life was done. This helped create a better picture of their lifestyle. Exploring these facets provide fodder for thought and made it easier to think and design for the elderly. The brainstorming inputs were categorized to relationships and sub groups.

CATEGORIES OF MEDICAL NON ADHERENCE 74

Bringing medicines home

To know them better, a brainstorm session with 30 elderly people at Nightingales Elder Activity Centre was conducted. Each of the brainstorm sheets that follow are a collection of the data taken at the sessions put into relevant categories.

Knitting groups

Siblings

-earn small wage -buy gifts for family -tutor friends

-discuss health problems -laugh about it to eachother -ask about family

Pass on family traditions

Satt-Sanng Laughter clubs Tease eachother

Go to elderly homes to chat & listen to them

Chai +vada

Pre-planning

birthday treats

-what to cook for guests -bank/bill errands - phone bills/rent

social organisation treat/camp Bond with strangers MAKE NEW FRIENDS

Activities

WALKS Proud Discussions

-write essays -REKI -yoga -gardening

Evening walk Morning walk Time to bond

SENSE OF RESPONSIBILITY

Daily Groups Contributing amongst friends gives them a sense of responsibility.

Fasts

-keep long fasts -wait for extreme health problem -make it a ego issue

Groups

-bridge -cards -housey -motivational talks/conselling

Organize events:Womenâ&#x20AC;&#x2122;s day

Weekly Social Groups

Re-runs

New discussions Varied outlook

New people Ex work friends Childhood friends -meet and reminiscence

PHONE CALLS

Short visits

Grandchildren

-small call, great happiness -proud of their achievements

Relatives

Proud Discussions

ACHIEVEMENTS ACHIEVEMENTS -discuss match -call if they canâ&#x20AC;&#x2122;t go to meet

Long Distance birthday

FRIENDS

holidays

Early morning calls Recall old memories FIRST ONES TO CALL

FAMILY

birth of a child yearly festivals

Things they love to share

Trips with family

staying with them for a while

Events

wedding

What do you see them enjoying?

Fav Serials

Gossip

Skype/ Phone calls with family

ENJOYMENT FOR THE ELDERLY

Long test matches Cricket match YOUTUBE

-read verses from religious books -discuss stories -exchange sweets and food -pot pourri -play host in rotation -cook & organise event -make something(gifts)

Part of cherished memories 77

Memories hold an integral place in their lives. Associate all with good old memories

Weekend visits

Weekly Social Groups

Daily Groups

birthday

FRIENDS

While studying the enjoyment factors in the life of an elderly, another important category emerged, emotions. Elderly associate a lot of emotions with the people, objects, activities around them. This led to a study of the emotional aspects for the elderly.

for a while

Long Distance

Events Weekend visits

birth of a child yearly festivals

ENJOYMENT FOR THE ELDERLY What do you see them enjoying?

Long test matches Cricket match YOUTUBE -info videos Memory re-runs -old family videos

wedding

Things they love to share

Fav Serials

Part of cherished memories

Re-runs

WATCH/LISTEN

Exchange books within family

READ Audio Books Old Music Storehouse of memories

Radio

Cassette Walkman

Fav channels

Cricket score

-while sleeping

Current News

Golden Era songs

Newspaper Current news State News Crosswords Editorials Read Re-read Discuss

-SpeciďŹ c times of the day -Associated with activity

Borrow books Nearby Library

Types: philosophy Books at home

Old books Pass on family Come with traditions memories

Spiritual reading Bhagvad Gita/Quraan/ Bible Ramayana Religious phrases

New Information

Cherish media of their age

Share opinion of books

regional language translations spiritual religion literature biographies history humour self help ďŹ ction

Unawareness frightens them Scared of hyped circumstances by people surrounding them

Don’t see anything to look forward to. ‘whats the point of getting well soon?’

Feel alone in the struggle

Anger and emotional outburst

Feel controlled Loss of independence

Escalate needs

Frequently moved to tears

DRUG INTERACTIONS

Complain/whine Increasing Interaction

Initially feel needed

Over Emotional

Shift in emotions

DEPRESSION

STAYING ALONE

ANXIETY

Agressive Defensive

FEAR OF ABANDONMENT

‘’If I tell my father to change his behaviour, very often---EMOTIONAL FALLOUT

HEALTH CHILDREN MOVE AWAY

FEAR OF LOSS OF PRIVACY

Deceive themselves and others

FAMILY

Try to avoid emotional stress DENY THE TRUTH

Don’t want to hear that they are not well

Listen to what they have to say

PROFOUND LOVE

Ignore problem till last minute Take time to accept the truth

EMOTIONAL ASPECTS FOR ELDERLY Not so good emotions

Happy emotions

Small Doings Give Them A Lot To Cherish SIMPLE SMILES

MEDIA FROM YESTERYEARS

LOYALTY

Gifts

-Keep reminents of gifts/memories Watch old movies through new medium

Relate old memories to old movies -recall incidents -relevance of songs -fav actors/actresses

Idealize

Something to latch on to for old times sake

ARTIFACTS Old address books Old walkman/ Radio Old wallet Old furniture

New age Tablets Mobile Cordless Phones

Glorify the past Repeat narration of incidents to who ever listens

MEMORIES

Give them something to talk about FAMILY STORYTELLER Carry forward legacy

-cooking -game -incident -relevant object -tradition

Like receiving bank withdrawl/ tranaction SMSs Like sharing info, shows that they know MORE

Feel in control

Center of attention in many scenarios Microsoft Word Like to write more Easier due to erase option (unlimited rewriting capabilities)

Google Like Learning new things Easy to access information Good tool to learn new things Share interesting stuff amongst group/family/ friends

Can afford to stumble, delete things accidently, and recover them

Understanding Elderly & Technology While trying to understand elderly, their interaction with technology was an important factor that needed to be studied.

Cant follow accents on audio instructions enabled phones

Denial mode Hypertension

Get extreme informationn which scares them Google

see relevant symtoms

associate with disease

Enables customized and personalized info

Timely use (morning radio/news)

Easy to use addons (SMS, bluetooth, sensors)

Audio communication

GADGETS USED

Faster Economical

blow the situation out of proportion

Response based monitoring Enable 2 way communication

TECHNOLOGY AND ELDERLY

Leads to frantic/anxious calls to family/ friend/ caregiver

Scared of experimenting

LEARNING CURVE Once they learn something new they STICK TO IT Finicky about getting back to old methods Get used to ease of use

Forget learning even after somebody teches them

Wait for grandson to come and perform task. Don’t risk

Little confusion leads to reorting to old familiar modes of operation

Read about hackers and feel unfamiliar websites will trick them Max tech questions were on privacy concerns

Feel tech leads to invasion of privacy

PRIVACY

Access to phone numbers, personal details, emails Refrain from booking tickets online Scared of putting bank details online

Don’t do money transactions in general over internet

Can’t be reason for isolation

REMOTE MONITORING TECHNIQUES THINGS TO KEEP IN MIND

Very slow learning curve

Mobile

Geographic mobility

Already know how to use them

Radio/music player

Easy to type

Depression

Easy to carry

Video +audio

Personal gadget

To get started, reading material available online and offline on this subject was explored. Some of the understanding gained has been given ahead. Through the data collected during the brainstorm sessions at the elder care centre, categories of the relationship between technology and elders started emerging.

Timely use (morning radio/news)

Email Most preferred medium

SOFTWARE & FEATURES

Health Related Look at Google for medical information

Before meeting doctor

Telivision

Resort back to typing More comfortable with it

Share interesting stuff amongst group/family/ friends

Affordable

Know how to use it

Hearing issue -insisted on loudspeaker/ headphones

Belongs to ONE person, easy to communicate sensitive info

Non- Intruisive Access to information ONLY when required. NO overload of information TIME CONTEXT SERVICE

Based System

Needs to be a hetergenous system -adaptable across devices -adapt to elderly activity Can’t be overbearing. Elderly should NOT feel surrounded /monitored by technology

WHEN TO FOLLOW EACH TYPE OF COMMUNICATION

As per the data obtained, motivation was a very important factor in the life of en elderly. As their physical health deteriorates, keeping them mentally healthy and positive was something that looked like a very important factor. How could this motivation be communicated to them? A crux of the ways of communication are given ahead.

MOTIVATION

EMOTIONAL Who conveys the message? Needs to believe in the medication system. Fellow ill/elderly

FINANCIAL Reduction in costs Reduces dependency?

Less learning curve Social isolation Motivate to use

GENTLE About illness Treatment and side effects

Rewards/surprises improvements

LIFESTYLE Intregrate within daily schedule

MEDICATION

Affect less change in daily life GEL INTO LIFE

Patient

Continued treatment for life, increase in costs?

UBIQUITOUS Invisible Technology Communication

Community Building Companionship

WHEN TO FOLLOW EACH TYPE OF COMMUNICATION Less learning curve 84 Social isolation

DIRECT Costs saved

seeks advice?

Qualities of solution

Family

INSIGHT GROUPING The insights gained through all the research, user studies and interviews have been categorized below. Opportunities for intervention have also been identified.

ELIMINATE ANXIETY

snooze patterns

involvement leads to adjustable plans sense of responsibilty

involve in planning med schedule

alarm patterns

alarm ringtone

REMINDERS

gel into current life

EASE ACCEPTANCE OF ILLNESS/CHANGE overlay new activities on old lifestyle

ADJUSTABLE SCHEDULING

invisible till required adaptable UI

colour/ large toffee/ dissolving packet

mobile wallpaper reflects condition

test change in hearing using apps

visible only when required

visually depict elderly health (remotely)

ABSTRACTION painting reflects adherence

COGNITIVE

friendly alarms to atract less attention

product designing ‘universal design’

medicine dose packets look attractive

visually appealing, interesting and adjustable

alarm format- sound/visual/ touch

ambience reflects health enhance features according to person

needs to look homely, gel into home

multi platform sounds which are familiar ALARMS visual and sound ques customize alarmas

Transparency COMMUNICATION

expired meds adherence report to pharmacist

Common platform for feedback from many doctors show benefits of taking medicines

quiz leads to alerts related to illness side effects communicated through info

not over doing it

medicine wise information and additional info

DOCTOR PATIENT INTERFACE

reflection of well being

POSITIVITY

chart out how NOT taking meds will lead to additional costs

emergency appointment for doctor

chart of meds taken

modular boxes

connected to eachother and cloud/hub locater for the boxes identify medicine through colour/shape/name -camera enabled automated -text recognition ubiquitous -colour recog identification - QRcode/bar code reader purpose (how its going to help)

consequences and unforseen additional treatment costs

options for alternative treatments from doc

source in info

one stop look on meds taken

show cost chart updated daily

COST

Connect with more people with similar problems

timing of medicine

COMMUNITY easily accessible from diff platforms

FAMILY

controlled commun

ication of info

connectivity with well wishers twitter duo

media sharing

old photos memories

instagram duo

facebook duo

defect alert on each function show how machine/app will ease a particular task ACCEPTANCE OF MACHINE

communicate daily statistics but still remind to call

use analogy of ‘companion’ for each activity

check on refill scheduling

GAMIFY

form should be friendly

FRIENDS discuss about health (TAG TEAM) problems evaluate eachother’s health

can help in seeing the need of investing in the solution

Redefine

INFORMATION ON MEDICINES cost implications

regulated videos/ reading material according to severity of illness

phone book access to all functions old functions ques relate to new functions

SELF EVALUATION self evaluate adherence repeated symptoms lead to booking appointment

How to encourage if the medicines don’t help?

I took that medicine for cholesterol for five months, I Still had to upgrade to a new one. What is the point?

tackle together

app design

DISCLAIMER

refill date

provide basic info on med

print booklet on use vioce guided procedures

connected to artifacts of their time questionaaire for daily reports

tips/ dosage specifications

learning curve needs to be reduced

connected to artifacts of their time simple activities to check health

side effects

PRESCRIPTION

remind them to connect with elderly

dual player games

name

simple app to show cost reflection

controlled dependence connect with fellow ill people

wearable computing -wristband -pendant -’reflection of health progress’

move dose groups around pill counter to check number of pills left/taken

history of effects/ med taken for future reference

record appointment

ORGANIZING MEDICINES

list of options given by the doctor

activity mapping

show progress charts

record instructions and tips given during appointment for future reference

one step to upload medicine from strips to boxes/machine

easy to move around the house

list/quiz on side effects and illnedd infographic on appointment details

targets to be acheived till next appointment

side effect monitoring

GROUPING AREAS FOR DESIGN INTERVENTION

ORGANIZING MEDICINES - easy to move around - simple to access medicines - easy to identify which medicine to take - easy to upload medicines - easy to change - more like a game - source of information for medicines - simple to identify if meds are taken - associate medicine timing with activity - open and carry box must be easy

PERSONAL INDIVIDUAL

ENVIRONMENT INTEGRATION - abstraction of health status - dynamic status - mobile wallpaper - living environment helps adhere

LIFESTYLE IMMEDIATE ENVIRONMENT

DOCTOR PATIENT INFO EXCHANGE APPOINTMENT INFO - tips & important points from appointment - doctor coordination - medicine side effects & info - communicate adherence level when needed EMERGENCY MEDICINE INFORMATION - list basic medicines that might be useful to patient

DIGITAL CONNECTIVITY

OUTSIDE ENVIRONMENT COMMUNITY SHARING

CONNECT & COMMUNICATE MEDICINE TIMINGS - integrate in lifestyle - adjust to ongoing activity - alarms that don’t startle - personalize alarms - snooze patterns - overlay new with old sound cues - visual & audio notifications - must be heard in all activities - multiple devices 90

ACCEPTANCE/ SEAMLESS INTEGRATION - overlay medicine schedule on old lifestyle - involve while planning to give a sense of responsibility - acceptance of treatment - accepting new technology(box) - easy to access & does not attract un due attention

FAMILY/ CAREGIVER - check on adherence remotely - don’t pester asking about medicines too often - indicate when refill is needed - too many snoozes and notify - keep the dialogue going - motivate the elderly - schedule calls 91

COMMUNITY/ FRIEND CIRCLE - discuss with fellow ill people - involve friends circle - incentive based sharing - Facebook duo - Twitter duo - tag teams to use two boxes

CONNECT & COMMUNICATE

ORGANISING MEDICINES INTERVENTIONS

TECHNOLOGY INVOLVED

Easy to move around

Form of box needs to be more compact. Needs to have handles for easy grip.

Form of the box

Simple to access medicines Easy to identify which medicine to take

Visual indications to identify medicines without reading the label

Phone camera and NFC can help identify the strips/ bottles

DESIGN INTERVENTIONS MEDICINE TIMINGS Integrate in lifestyle

Easy to change Gamify

Step by step instructions to load medicines in a box. Store bulk medicines together. Makes changing them easier Communicate adherence data via cloud and involve family/friends

Source of information for medicines

Digital Connect

Mobile game

Give easy access buttons to medicine relevant information

Interface/box

Allow access to regulated information safe for the patient to follow

Voice instructions/ online database

Simple to identify if medicines are taken

Load sensor to understand number of pills left. Sensor to detect strip opening Packaging and weight sensor

Associate medicine timing with activity

Adjustable timing through the phone. Detect activity such as sleeping, watching TV

Open & carry box must be easy

Take correct medicine

Digital Interface

Phone alarms and scheduling

Alarms that don't startle

Sensor based

Auto dispense correct medicine and quantity

Dispensing mechanism

Form 92

Personalised alarms with adjustable volume

Mobile or wrist band

Visual cue with increasing alarm sound Snooze patterns

Adjustable medicine timing. Snooze limits need to be set. Mobile or external alarm system

Overlay new and old sound cues

Current beep sounds need to be overlays with customized sounds.

Must be heard in all activities

Multiple devices

Simple opening and closign mechanism. Automatic close will ensure safety of medicines Form of the box Give access to the correct medicine box only

Adjustable timing through the phone. Detect activity such as sleeping, watching TV

Adjust to ongoing activity

Bar code/rfid reader to identify medicines Easy to upload medicines

TECHNOLOGY INVOLVED

Digital Interface

Visual & audio notifications

The device needs to be with the patient at all times. The notification needs to be audio and visual so that it can be noticed in all situations. The information needs to be accessible across many devices, so that various stake holders can access it in real time. The box and digital devices need to be connected so that medicine Digital interface on box, mobile phone, transactions can be automatically updated. tablet, computer screen connectivity

Form

Sensor based

Sensor based 93

DOCTOR PATIENT INFORMATION EXCHANGE

ENVIRONMENT INTEGRATION DESIGN INTERVENTIONS

TECHNOLOGY INVOLVED

Abstraction of health status

Dynamic data viz to show the adherence level followed by the patient

Dynamic status

The space where the patient lives reflects the adherence level

APPOINTMENT INFORMATION

Tips & important points from appointment

Dynamic painting pattern, lighting effects

overlay medicine schedule on old lifestyle

involve while planning to give a sense of responsibility

TECHNOLOGY INVOLVED

Record information collected in the appointment, with Digital record accessible from the cloud. Tags in the tags at important places appointment to easily access the information later.

Doctor co-ordination

Access information to adherence level during appointment easily

Digital Connectivity

Medicine side effects & information

Barcode or RFID on medicine strip or bottle should give personalised information related to side efffects as per the patient

RFID/ barcode/ Text reader/ colour detection

Auto update adherence level

Digital Connectivity

DESIGN INTERVENTIONS

TECHNOLOGY INVOLVED

General information accessible through common platform

Digital interface and easy to carry print

DESIGN INTERVENTIONS

TECHNOLOGY INVOLVED

Phone notification:'med not taken call father'

ACCEPTANCE/ SEEMLESS INTEGRATION DESIGN INTERVENTIONS

TECHNOLOGY INVOLVED

DESIGN INTERVENTIONS

Communicate adherence level when needed

Digital interface info arch Allow the medicine schedule to have flexibility so that the patient can easily adhere to the schedule Medicine timing should be decided by the pharmacist/family member/ pharmacist and the elderly

EMERGENCY MEDICINE INFORMATION

Movable buttons on box to adjust timing List basic medicines that might be useful to patient

Digital interface, which uploads data on cloud; accessible from all digital interfaces FAMILY/ CAREGIVER

acceptance of treatment

accepting new technology

does not attract undue attention Digital Interface

Communicating the information and treatment to the elderly effectively. Show costs saved

Digital interface; data communication and easy access to medicine info

check on adherence remotely

Use familiar and new ways of interaction

Forms: physical buttons, knobs, sliders

donâ&#x20AC;&#x2122;t pester asking about medicines too often

Indication when medicines are not taken on time

Interface: Big buttons, space for error in click (view guidelines)

indicate when refill is needed

App to schedule refill timing, get alert when box is not functioning or medicine refill is needed Digital Connectivity, Lights on box indicates refill

too many snoozes and notify

After limited number of snoozes, app reports medicine not taken Digital Connectivity

Represent data with abstraction, should look familiar and visually appealing

Form

Visual and sound cues

Sensor based 94

keep the dialogue going motivate the elderly

Memory log to increase attachment Send messages, videos, notes to keep the conversation running

REDEFINE DESIGN BRIEF

COMMUNITY/ FRIEND CIRCLE TECHNOLOGY INVOLVED

Connect elderly to facilitate communication and sharing within them

Digital Connectivity

Regulate sharing of health related information between them Groups and tasks, digital connect

Medication box and digital interfaces

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Sensor based

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Form

ORGANISING & MONITORING

10KL

Social networking duo

Connect to social networking crowd and gamify adhering to medications

10KL

Connected medicine boxes

10K

Tag teams who use two boxes and motivate eachother

incentive based sharing

Digital Interface

Medication adherence needs to be tackled at various levels within the life of the elderly. Organising medicines properly or assigning reminders at the time of dose alone will help but not solve the problem of medical nonadherence.

10K

Form help forums and give responsibility to each one

From the research & observations done during this project, a sound understanding of the needs of the elderly with respect to medical adherence and management was obtained.

:90DF HT

discuss with fellow ill people

INTERVENTIONS

When the patient gets long term medication, it becomes a new addition in his life. Medication is perceived as a cure, additional costs, side effects and a life time of dependency. As the long term medication might not show immediate effect on health, but help over a long period of time, the elderly often tend to start taking the medication lightly.’ A couple of doses missed won’t matter’. In some cases it might not, but it depends on the medicine also. This action of skipping doses and taking the medicines lightly if not monitored and curbed can soon develop into a habit. Monitoring of medication is an important part of the medication system. Automating this is essential as long term medication tend to be overlooked after a certain point of time. But if the medicine transactions are automatically monitored, then the data can be accessed when required by various stake holders. To make sure the elderly realise the long term contribution that the medicines have made to their well being, the gradual progress of the medicines needs to be recorded and communicated to the elderly over time. Small advances in health which are reflected in vital reports or the costs saved on sudden hospitalization are some factors that can be highlighted. The medication helps the elderly do some activities in their everyday lives that they might not have been able to do otherwise. These can be related to their everyday chores, interacting with their grandchildren, enjoying with friends or even contributing to society in some way. These advantages can be noted and stored to form cherished memories over time. Every time the elderly feel like ignoring their schedule, these memories can be highlighted to help motivate them.

FLEXIBILITY AND ADAPTING

Each one has a unique way of keeping their medications, handling their everyday medical needs. The design solution needs to add on and work around the habit of the elderly. An entire new system of handling will be overwhelming and too much to learn for an elder. Hence, either the system has to be really flexible in it’s approach or it has to involve very less and simple interactions with the patient.

COMMUNICATION

Motivation can also come from their family and friends. When a person takes short term medication after an accident or sudden hospitalization, the whole attention of the family gets concentrated on the person’s fast recovery. The elderly are showered with domestic help, attention from family and friends, frequent tests, monitoring and a little bit of pity. This helps them see that people care for them and want to get well soon. To get away from the pity, they start showing that they are well and hearty to go about their lives.

MOTIVATION

So how can the adherence be communicated? Communication needs to be real time and instant. It also needs to be visible only when required. Too many notifications or alarms will just be perceived as annoying. Also too many number and statistics will be cumbersome to read and analyse every time. Abstracting the way medication data, adherence level and heath of the elder will help enhance the experience. With one glance at the abstract representation, the person should be able to get a fair idea of the status. This abstraction can be in terms of data visualization, colours, environment graphics or even embedded in the immediate environment of the user.

As they get well, this attention and other resources around them start reducing. The doctor monitoring reduces, the short term medications reduce and some long term medicines stick. Family and friends start getting back into their own lives and the attention given to the elderly gets divided. This leads to the elderly being on their own at home, with some restrictions on their everyday activities and a set of long term medications. This withdrawal of attention from family and friends can lead to the elderly feeling de motivated and unwanted. They are left to tackle so many new issues on their own that they start craving for the attention. Extreme conditions can lead to them not taking medication to relapse, just to get that attention back. The other side is too much attention. The family gets so worried about the elderly that they ask about their health and try to regulate their every move a bit too much. This can lead to withdrawal, irritation and a sense of weakness in the elder’s mind. To avoid such extremities, a fine balance needs to be maintained between how to interfere and where to draw the line. Hence, motivation and communication through family and friends is very important. Leveraging commonalities like sharing memories, scheduling call reminders on both ends, sharing media with each other, can keep the communication going yet not interfere too much in the elder’s life. Making this communication an easy to do and great experience for the elder and younger generation is the key to involving both parties.

INTERACTION WITH TECHNOLOGY

The more the technology involved the more apprehensive and reluctant an elderly can be to use it. However complicated the technology is, the interactions of the elder with the machine need to be: minimal, familiar and ease to learn. Without these three considerations, the elder might not even want to use the solution proposed. Back up of data, functionality without cloud connectivity and planning for system failures is an essential part of the system too. In no condition should depending on a technology prove disastrous for the elderly. A basic mechanism to operate manually in case of emergencies is an essential component of any solution proposed.

This motivation is not just limited to family but also friends. In fact, nobody understands the mind and problems of an elderly than a fellow elder. Involving them in motivating each other to take their medication will not only increase a sense of brotherhood but also remove the notion of ‘Taking medication is a sign of weakness’ from their minds. Sharing and being a tag team might be of great help. Of course this needs to be regulated, as creating a fixed pair can lead to dependency on each other. If anything goes wrong with any one of them, it can be devastating for the other. Rotating tag teams or a larger group will make greater sense. 98

Use minimalistic design to prevent cognitive overload For maximum legibility text size of font should be RESPONSIVE DESIGN Text properties should to be adjustable as per the userâ&#x20AC;&#x2122;s needs.

Minimum font size: 12 or 14 Points for body text Medium or Bold weightage

Fonts:

ArialH elvetica Roboto Increased leading

Adjust kerning and leading to enhance readability

Increased kerning

INTERFACE DESIGN AND USABILITY GUIDELINES FOR THE ELDERLY To design interface for the elderly usability elements in to interface had to be considered. Guideline for font, colour contrast, icons, button sizes and interactions had to be defined so that the interface would be of greater use and efficient for the elderly. Reading research papers on the elderly interfaces and interactions helped define a well rounded set of guidelines for this project.

QWERTY Keyboard Provide adeaqute wait and response time for the user to input text. Make presets of commonly used texts.

Task based functions Only relevant features that will be needed to perform a certain task should be made available. Avoid use of the scrolling functionality on the screen. Reduce anxiety while using device by using functions familiar to the user.

Use short straightforward sentences. Break long paragraphs into smaller ones. Use active voice. Standardize format

Use of large buttons to account for imprecise mouse positioning. Standardize icon styles. ALPHABET Use familiar icons

Simple navigation buttons Should be able to track their path very easily. Prominent HOME button can be useful. Use shallow heirarchies. Show sitemaps and breadcrumbs.

Clear print based instruction, prominent help screens

Provide large icons that are easy to interpret for function and interaction logic

Visual/audio feedback on click

Use single click access to information Allow maximum information on one screen.

Limit use of multi-touch gestures

Provide sense of accomplishment when certain tasks are completed.

Reduced motor abilities might make using scrolling lists and

Provide feedback when action is complete 100

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USE OF COLOUR IN INTERFACE CONTRAST IS KEY

Text Sizes

Sub Text

12points

Body Text

14points

Title/Headline text Button text

16points

Big Text on page

18points

Username 17pt Charlie 14pt

UI assets developed on the basis of the guidelines for elderly.

568

FORGOT USERNAME

TIMETABLE

568 Only icon for simple actions

CLICKED

Text+icon for complex actions

NORMAL

HELP BAR HOME ALARM INFO HELP BAR HOME ALARMI

NFOS

SAVE AVE

CLICK&DRAG &DRAG CLICK

http://psychology.wichita.edu/hci/projects/elderly.pdf

References for this section

http://www.uxmatters.com/mt/archives/2006/01/color-theory-for-digital-displays-a-quick-reference-part-i.php http://www.geengee.eu/geengee/geengee-docs/contenuti/comune/web%202%200%20seniors_v9.pdf

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CONCEPT BUILDING The design process followed led to conceptualizing an ideal scenario for the elderly to manage their medicines. Given ahead is a process flow for the elderly from falling ill to taking the medicine dose. Various concepts have been proposed at various stages in the process.

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PROBLEMS BEING ADDRESSED:

1. Avoid anxiety and stress caused by searching symptoms and information on the internet. Adverse information can scare the elder. 2. Make recall of information discussed in appointment easy.

RECORD APPOINTMENTS:

During the patient-doctor appointment a lot of information and tips regarding the patientâ&#x20AC;&#x2122;s health, medicine schedule, do and donâ&#x20AC;&#x2122;ts is given. To enable the patient to recall this information on a later day, a mobile application that records and tags the different instruction is required. This application allows the doctor and patient to tag and segregate the information discussed. It also allows the doctor to create a repository of media useful for the patient to see on a later date.

Doctors appointment Doctor gives tests, analyses reports 106

Instructions Dosage information Medicine side effect precautions 107

Patient & family leave

Leave with: Illness Prescription Reports Lots of information

PROCESS 2: MEDICINE SCHEDULE 1. Application on tablet helps the user and pharmacist assign a medicine schedule to the patient according to his daily time table.

PROBLEM BEING ADDRESSED: Make it easy to identify medicines at the time of dose. Also provide adequate information about medicine and adherence level.

PROCESS 1: 1. Elderly visits pharmacist with prescription

Take prescription to the pharmacist

2. Pharmacist puts number and colour code stickers on each strip/bottle. 3. Pharmacist open application on his tablet 108

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2. The pharmacist and patient enter the patientâ&#x20AC;&#x2122;s daily schedule and assign medicine timings in it.

3. Review Screen: The pharmacist and patient can review the schedule and confirm it.

The pharmacist also gets alerts for any drug reactions that happen in the schedule.

This schedule is then sent to the cloud storage. It can be accessed from any digital device with proper authentication.

Pharmacist gives medicines & medicine schedule

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ORGANISING MEDICINES Organising medicines in a timely and systematic manner is essential for the patient to access and take the medicines easily. Organising begins from understanding the schedule and medicine names. After understanding, the patient needs to be able to access the correct medicines with least effort at every dose time. The way to access needs to be simple and standard, so that it does not seem like an additional â&#x20AC;&#x2DC;taskâ&#x20AC;&#x2122; to be performed and learnt. To do this various concepts for organizing medicines were proposed.

Patient organising the medicines according to the medicine schedule

Patient takes the medicines home

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To understand the different patterns of medicine doses as compared to the patientâ&#x20AC;&#x2122;s daily schedule, a chart of the medicines they take over a period of three months was made. The different permutations and combinations were sourced from the information obtained during the user research.

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CONCEPT LEVEL 1

ORGANISING MEDICINES: CONCEPT 1

The first concept consisted of storing the medicines in bulk. The bottles would glow to indicate, which medicines the person had to take at a particular time. The bottles would be connected to a wireless hub. This would allow easy update of the medication schedule and easy replacement of medicines. The visual indication for which medicine to take, was proposed to ensure lesser number of wrong doses taken by the patient.

To make carrying the bulk medicine around easier, a form intervention was needed. The bottle size considered in this example is a 13dram pill vail. The pill bottles would be placed in a circular pattern. Medicine from the strips would have to be emptied in the bottles the first time. The lid of the box has strips for each bottle. These indicate the medicines that will be dispensed. The dispensed medicines are collected in the base of the box.

The bottles would consist of load sensors to automatically measure the number of pills left in each bottle.

The patient has to remove the base and take the medicines.

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MODULAR & ADAPTABLE While travelling the elderly are often required to carry medicines and Cap Sensor: a bottle of water around. To make this easier for the elder a cap and thermos system has been proposed.

This concept is to ensure that patients swallow their medicines.

* 40AKS

For example: a medicine dose that is near to sleeping time is kept at the bedside. To enable the medicine dispenser to do so, a medicine dock was proposed. The elderly has to dispense the medicines from the main box before time and stack all the lids together.

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Understanding of how the elderly keep their medicines showed that they prefer keeping their medicines near the place of intake.

The lid also detects if the user has taken all the pills or not. If not the lid keeps glowing RED. The user also gets an alert on his phone, if the medicines are not taken after a certain period of time.

90 HT: DF

The patient uses the feature in the box to dispense Monday- Sunday night time medicines in different base caps( from previous concept).

These are stackable and are fit one on top of the other. Every day, an LED on a lid glows and alerts the elder to take the medicine. The elder can only open the designated cap at that time. Once the pills are taken(load sensor detection) , the LED switches off and dose taken is recorded.

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Example: Time of dose: Night time, before sleeping Number of pills: 6

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MODULAR & ADAPTABLE

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The glass of water has a cap which contains the medicines. The lids( from the previous concept) are an easy fit on the water thermos. The user simply has to fill water in the thermos and fix the lids oncap thesenses thermos. time itâ&#x20AC;&#x2122;s time a dose,whether the userthe has The theEvery TILT and LOAD on itto totake determine topatient fix that has lid and tilt and drink. The medicines are dispensed first and taken the medicine or not. then the water.

KL 10

OPPORTUNITIES BEING ADDRESSED:

1. making the process as simple and mindless as possible 2. enhancing the medicine taking experience 3. one point solution for all medicine related info 4. reduce the errors while extracting medicines

This organisng medicines concept revolves around connecting the boxes together and making the boxes modular. The boxes are initially connected to a central part that forms the main hub of the box. This hub connects to the internet and records all the medicine transactions.

Box indicates when it is time to take medicine from it. It has an LED that glows to indicate.

The boxes have a tracker, speaker and LED. The tracker to enable the user to easily find each box. The LED is a visual indication when its time to take the medicine and the speaker gives an audio alarm.

Roles of different stakeholders in the process: PLEASE TAKE YOUR PILLS

PHARMACIST:

- gets a notification 3 days before refill - call notification REFILL: - has to empty box and add new meds

PLEASE TAKE YOUR PILLS

TIME TABLE: - plan a new timetable with the user - program the bottles on the website accordingly - test once

FAMILY:

Central part connects wirelessly and shows: - number of pills in that dose - colour combination of boxes - adherence level

- gets a notification 3 days before refill - call notification as a reminder - adherence levels can be checked - send surprises to the elderly - notified when adherence levels fall drastically

ELDERLY:

WAY OF LOADING: - user has to empty the bottle of medicines into each box - assigned box and medicine on phone - lid closing indicates filling complete ALARM PATTERNS: - each box has a glowing lid that indicates if the medicine has to be taken or not - sound alarm & LED glowing to indicate which medicine to take WAYS OF REFILL OR CHANGE: - box has to be taken out and emptied - new medicines can be loaded in that box

ACCESS/ EXTRACT MEDICINES: - push lid down to open it. - shallow box ensures its easy to take out medicine - push lid to close again

TIME TABLE: - know the timetable - get notified when user changes timings 120

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MOTIVATION To encourage the patient to take their medication, motivating them is very essential. This , for instance, can mean showing them advantages of their medications, additional information on their medication, support from friends and family. Some concepts to motivate the elderly are given ahead.

CONCEPT 1 This concept consists of giving a new dimension to the simple medication box. The box of medicines is perceived with various negative conotations, such as a burden, dependency, adverse side effects. To make the patient aware of the positive effects of the medicines, the user needs to be made aware of the positive effects easily. To change the perception, each box needs to be colour coded. As the patient moves his phone over the box, a new layer of positive information is communicated through images, text and audio. (Examples of positive effects: helped reduce pain, could do more chores, avoid operation costs and pain)

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CONCEPT 2 This application consists of two processes: PROCESS 1: To create a memory log of the positive effects of medication on the paitient, the application encourages him/her to record/capture a memory when it takes place. The application then stores it with a title, date and time in its repository. These can be viewed at any time by the patient. PROCESS 2: At the time of a dose if the patient clicks skip dose or snooze, then to discourage the patient from skipping a medicine dose, this mobile application shows the patient the positive effects that medication has had on him over a period of time.The application shows a data visualisation that shows the patient the stages of progress he has madeover a period of time. The patient can also click on any memory and hear/see it.

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ELDER’S POINT OF VIEW

The elderly can check his weekly or monthly adherence level through his phone.

CONCEPT 3 This application consists of two processes:

He can then check vitals and health improvement. It also enables him to share his progress.

Friends and family linked with the elderly can send cheers to motivate the elderly.

Elderly can also view rewards & gifts shared by friends & family.

FAMILY, FRIENDS, CAREGIVER POINT OF VIEW

PROCESS 1: To create a memory log of the positive effects of medication on the paitient, the application encourages him/her to record/capture a memory when it takes place. The application then stores it with a title, date and time in its repository. These can be viewed at any time by the patient. PROCESS 2: At the time of a dose if the patient clicks skip dose or snooze, then to discourage the patient from skipping a medicine dose, this mobile application shows the patient the positive effects that medication has had on him over a period of time.The application shows a data visualisation that shows the patient the stages of progress he has madeover a period of time. The patient can also click on any memory and hear/see it.

Child/ friend can view health & adherence level of patient.

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To applaud & motivate, the family/ friend can send surprises.

This can act as a ‘ act of care’ between the two.

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The elderly sees this support & feels motivated to get better by taking medications.

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CONCEPT 4 Motivation from friends is the crux of this concept. Most of the elder persons have a circle of friends with whom they interact on a frequent basis. They share and talk about each otherâ&#x20AC;&#x2122;s experiences and problem. Nobody understand their troubles like a fellow elderly. Medical adherence too can benefit from this bond. The connectivity between two or more friends who can encourage each other to take medicines will be of great help in this case. They all are under some medication, so the pride factor will play a lesser role in this interaction. With gamification and simple tasks, two elders can encourage each other to take medications. For example: If one elder, Raam, takes his dose on time, then Shanti( his friend) will receive an intimation/ alert that Raam has taken his medicine. She will also get a point for the same. If Raam does not take his medicine, then Shanti will loose a point in the game. This holds true vice versa. With this sort of interaction between the two, they will be on the look out for each otherâ&#x20AC;&#x2122;s health and be more accountable for their own medication adherence.

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DATA VISUALIZATION To give the patient and the family members in the house an idea of the adherence level of the elderly the representation of the statistics were embedded in a data visualization. But this data visualization could not be unfamiliar and daunting. It had to seamlessly fit into the surroundings of the elderly. Hence, a concept was developed to integrate these statistics into a pattern based painting. Various parts of the painting would light up to show the adherence level for each medicine.

As the elder takes medicines, the pattern starts filling up. The empty parts indicate doses not taken.

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REMINDERS For the elder to take medicines on time, it is essential that he hears and responds to the reminders. If he canâ&#x20AC;&#x2122;t hear the sound of the alarm then he will not remember to take the medicines. Even if he does remember, there are chances that he might be too engrossed in the ongoing activity(Example: watching telivision, listening to music, gone for a walk). This concept deals with simple and efficient reminder systems for the elderly.

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MEDICINE ALARMS Apart from a reminder system, the alarms itself should be personalized for the elder. An automated beep can be ignored, but a favourite song or a message from a loved one is more difficult to ignore. Alarm systems are further explored in this concept.

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A basic medicine schedule was considered. This helped channelise the processes in organising medicines. Four medicines a day for a duration of 3 months have ben considered.

KEY MODEL

MAIN CONCEPT FOR HONEYWELL Keeping in mind the marketing objectives of the company, project discussions lef to selecting the following concept as the final deliverables. The exploration of the needs and requirements in the project led to proposing an organizing medicines concept at the core. Peripheral applications have been proposed to support the main concept.

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PROCESS FLOW: SETTING UP THE BOX

He opens the box to load the medicines

The mobile application helps the patient load the cap on the correct bottle

Each bottle gets a cap, which is unique to each slot The bar code on the bottle is scanned by the mobile before loading. The application helps the patient verify if the correct medicine has been loaded in the correct slot

After planning the schedule

Patient gets medications and prescription home The box then verifies each slot, bottle and cap. Only after complete verification is the schedule approved.

Verify if loaded Verify ifproperly loaded properly

If not, a call is placed to the caregiver/ family member for assistance.

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PROCESS FLOW: TAKING THE MEDICATION The adherence chart in the mobile application gets updated to show the patient the progress he has made The patient has to press the button to dispense

An alert is sent to the patients family/pharmacist The patient removes the cup and has the medicine

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BUTTON TO DISPENSE

The bottles dispense pills according to preset into the cup below

:90DF HT

Customized alarm tone alerts the patient that it is time for medicine

KNOB TO DISPENSE

OR manually turn the knobs in front of the bottles where the LED is ON

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PRELIMINARY SKETCHES AND 3D RENDERS 152

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CAP MECHANISM

3D renders of the cap and a 13dram pill vail.

The dispensing mechanism housed in the bottle cap is designed in such a way that it dispenses only one pill at a time.

These three levels are fixed on a common axle that rotates each level separately,

Top view of cap levels 1,2&3 when aligned.

LEVEL1: Has a tapering hole that gathers the pills towards it, and reduces the pills that pass to 1 or 2. LEVEL2: The hole narrows further to store only one pill at a time.

LEVEL3: This level ensures that the pill is dispensed only at the right time. Till it aligns the pill cannot pass.

GROOVES Each bottle cap consists of grooves on the side. These ensure that the bottle fits only into the correct groove.

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The cap has a provision to plug into the box and two grooves to align them on the side. It also has a curve and smaller grooves for ease of hold.

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The box does not contain sharp edges so that it does not harm the elder. The texture of the box lid and cup ensures easy grip for the elder The box also has a mobile dock that is collapse able. It also charges the phone. The box has provisions to be either kept on a table or hung on the wall.

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Default screen on application

Alarm indicating â&#x20AC;&#x2DC;Time of Medicineâ&#x20AC;&#x2122; The alarm customised and personalised. Example: Video of grandchild asking grandad to take medicine. The page also has a SNOOZE button and a DISPENSE button

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Snooze Screen: Allows the user to postpone the medicine timing by a specific time frame.

Setting up new medicines: The application connects with the cloud to download new medicine schedule. The user just has to scan the barcode on the medicine bottle/strip to identify the medicine.

The application indicates which slot the bottle of medicines is supposed to go into. More Information screen: This screen allows the user to call specific people for more information on medicine. It also provides the user with additional information on medicines. Has provision to send report to family.

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Follow same procedure for all medicines.

After all the bottles are placed. The application verifies the bottles using a barcode/colour scanner.

Only after all the medicines and bottles are verified, does the application approve the new medication schedule.

Follow same procedure for all medicines.

Any abnormalities and a call is placed to the caregiver for assistance.

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FUTURE OUTLOOK

CONCLUSION

This proposal can be further expanded in many ways.

What is my conclusion?

1. Modular Box: Currently the box supports only four unique medicines. To suit the changing number of medicines used by the elder, a modular system in which an attachment can be addedto increase the number of medicines or even remove the unwanted bottles can be integrated. This would mean that the elderl just has to buy a main box and then smaller attachments for his growing needs. 2. Cutting Medicines: The bottles currently dispense only whole pills. Cutting or curshing mechanisms need to be integrated to allow the elder to stick to the doctorâ&#x20AC;&#x2122;s specifications. 3. Adjustable bottle caps: Currently the caps fit only on a standar 13dram pill vail. Although this is the standard size of bottles given, the provision for adjusting to more sizes must also be there. The range it needs to cater to is 1inch to 2inch diameter. 4. Pill Mechanism: The mechanism can be further refined to accommodate larger pills and capsules. Currently a standard 1cm tablet and 2 cm capsule have been considered.

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