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Application of Embedded System for Home Care and Health Management Jyh-Perng Fang and Yang-Lang Chang
National Taipei University of Technology, Taipei, Taiwan
Non-compliance and inappropriate usage of medication are common problems found among the elderly, especially
in the environment of home care. To address these problems, a drug dispenser is developed with the following goals:
(1) to provide an intelligent medication reminder device, (2) to construct a remote monitoring mechanism to check
for continuous medication compliance, and (3) to implement the whole system in an acceptable cost, and (4) to
minimize the power consumption of the whole system. The proposed drug dispenser is not only useful in the
environment of home care but is suitable for health management as well.
Keywords - home care, health management, drug dispenser, embedded system. Introduction
and other disabilities such as dementia [3, 4]. With the
boost of aging population around the world,
Traditionally, medication is considered as the most
non-compliance of medication has become the major
preferred treatment after visiting a doctor. For example,
source that degrades the effect of medical treatment. For
averagely a person visits outpatient clinics in Taiwan the medications cost in nursing homes, it is estimated
more than ten times per year and a physician prescribes
that more than one-thirds is needed to manage
over four kinds of drugs on average during each visit.
medication-related events . In addition, it frequently
While medication assists a patient recovering from
causes unnecessary request for emergency services and
attack of sickness, to take a large combination of drugs
preventable visits to hospital, which accordingly raise
implicates that a patient is exposed to a high risk of the healthcare expenditure for the elderly.
medication non-compliance, improper medication usage,
Taking medication at wrong time, or not taking
and adverse drug interactions [1, 2]. These are referred
right dosages as prescribed by physicians are examples
as the polypharmacy problems, which are concerned of non-compliance and improper medication usage. To
especially for the elderly patients. On account of the remind patients when and how much to take their
compound of multiple chronic diseases, it is unseldom medication, there has been kinds of medication
that the elderly patients visit physicians with different compliance aids devices introduced [6-8]. For example,
specialties and bring home a larger combination of one such a medication device have weekly-based daily
medication than average-age patients do. Consequently,
compartments, which are each divided into sections.
the elderly patients are more susceptible to the problems
Each section in a compartment corresponds to a
of polypharmacy and thus to the risk of adverse specified time point of a day, e.g., breakfast, lunch,
reactions because of unwanted or unpredicted drugs evening meal, and night meal. Even if these medication
devices provide certain assistance for patients in their
Non-compliance of medication origin from medication usage and compliance, those devices are
declining cognition caused by the natural aging process
This work was supported by the National Science Council, Taiwan, under Grant No. NSC 93-2215-E-002-010/006.
(1) The device works only if the patient is automatically dumped into the cup. If the switch is not
pressed for a predefined time period after the audio
(2) Most of the devices are not active reminder alarm beeps for taking medication, not only a remote
connection is immediately initiated to invoke necessary
(3) There is no logging function provided for actions, but a log mechanism (not shown) is started to
(4) Mechanism for preventing adverse drug reaction
management cost of ADR is the same as the cost of
prescribed medication. An important yet preventable
type of ADR is the interaction between drugs. As the
elderly usually have multiple chronic diseases treated by
physicians with different specialties, these patients
frequently received medication from different doctors
without double-checking for unwanted drug interaction.
Therefore it is important to have a patient safety device
The drug dispenser includes the following key
Basically, the drug dispenser proposed works as a
multi-function medication reminder, which not only
serves as an assistant for medication compliance of
(1) Manual loading to and auto unloading from
home-cared elderly, but helps ordinary adults who take
The drug dispenser contains a drug-dumping chute
(2) Timed release function that limits the access
that a patient can take drugs from while functions for
reminding, monitoring, logging, and communication are
(3) Timed alarm function with time display and
reminding alarm are provided to indicate that
An illustrative view of the drug dispenser as
proposed is shown in Fig. 1, in which time display and
alarm components are attached, and compartments are B. Adverse Drug Reaction Prevention.
each divided into sections for loading distinct drugs for
specified time for medication. The drugs are loaded
Table 1 shows the most popular method to
manually once every two or three days. Each section
quantify clinical significance of drug interactions.
corresponds to a kind of drug at specified time for
Two dimension (severity and documentation) rating
medication, and drugs in one or more sections are
scales are used to classify 5 levels of significance.
dumped at each specified time for medication.
Level 1 represents the most severe drug interaction.
Whenever time for medication is due, audio alarm is
Level 2 represent moderate severity. Level 3 to 5 are
activated to remind the patient that it is time to take
rated as minor severity or not well documented.
medicine. The patient or the one who is responsible for
Table 2 has two examples of drug interaction
taking care of patient accordingly puts a cup under the
pair. In this study only level 1 (about 100 pairs of
dumping chute. After pressing a switch, drugs are
drug interaction) and level 2 (about 200 pairs of
Table 1: The drug interaction significance scale
Whenever the compliance of medication is
violated, the alarm mechanism is initiated
accordingly, which includes voice/visual alarm, and
the drug dispenser is remotely connected to the host
site automatically such that the medical personnel at
the host site can communicate with the patient at the
drug interaction) are included in the database of the
client site or take necessary actions in time. To meet
the requirement of medication compliance
monitoring, auto dial as well as short message
Table 2: Examples of drug interaction with level 1
III. Power Saving Aminoglycosides:Loop
The drug dispenser introduced in this paper is
indeed an SOC-based embedded system , on which
a motor-control mechanism, a certain amount of sensors,
and a wired/wireless network interface  are equipped
to afford the medication-compliance related functions
described above. The system is experimentally
developed both on platforms as shown in Fig. 3(a) and
3(b), where Fig. 3(a) is an 8951-based circuit and Fig.
aM1A:Perform baseline hearing testb
3(b) is an S3C4510-based circuit. However, to drive the
M1B:Periodic monitoring hearing test
cM1C:Dose of one or both drugs in renal dysfunction patients
whole system, a significant amount of power is required
dM2A:Monitor hemodynamic function
. To save the power consumption in such an
eM2B: Administer inotropic, chronotropic and pressor support
embedded system, a software-based power saving
In the following, techniques for reducing
A look up table (LUT) based on Table 2 is built into
communication time and code optimization  are
the drug dispenser, as shown in Fig. 2, in which the
described, in which the hardware as well as operating
adverse dugs  are cross-referenced. In the LUT,
system are assumed to have been decided as shown in
not only the drugs with adverse effect are recorded,
shadowed region in Fig. 4(a). Also, for clarity, the
but the effect and the management steps may be procedure of system configuration that typically used for
listed as well. Whenever a drug name is entered, the
dismounting redundant drivers, as shown in Fig. 4(b) is
drug dispenser automatically searches LUT to not introduced herein.
identify the condition of adverse drugs. To
implement this feature, a database of drugs is A. Command-driven communication
Handle for message rather than message itself is
transferred during communication, the receiver
treats the received handle as an index on a pre-built
message table for retrieving real message.
Adequate algorithms such as dynamic programming
are adopted to avoid wasting resource caused by
For example, operations of multiply or divide are
replaced with operations of add or subtract. Further,
some operations of multiply or divide are replaced
D. Reduction of overhead on control-transfer
For example, function calls are replaced with IV. Implementation
macros, the overhead on control-transfer is thus
The drug dispenser is developed following an
incremental and iterative design process .
Generally speaking, in phase I, functions for
For example, frequently used variables can be medication reminding are involved. Also, tradeoffs
declared to reside in registers rather than memory.
between accuracy as well as portability and power
efficient are simultaneously considered in this
phase. In phase II, a LUT is integrated into the drug
Idle devices are turned off through software control.
dispenser and interactive mechanism is provided to
detect ADR. In phase III, the system will be
G. Always route through a less power-consumption deployed in the nursing home and/or hospitals in
order to evaluate its effectiveness as well as its
For example, suppose there are two paths available
feasibility. For each design phase, as a part of the
for communicating with the host site: wired and incremental and iterative design process, the drug
wireless. The wired path will be a better choice dispenser is incrementally improved in accordance
with the evaluation results during previous design
non-compliance and inappropriate usage of medication.
The design phase is incremental and iterative. As an
Fig. 3: Platform for developing drug dispenser
SOC-based embedded system, its major functionalities
have been simulated and its power consumption has
been analyzed and ameliorated on developing platforms.
A prototype has been constructed according to the
analyses and evaluations performed in preceding design
phases and is now used as a vitamin dispenser on a daily
base. What has been verified in the trial use includes the
functions of medication reminding, mechanism of
loading and dumping drugs, and the ability of remote
In the long run, it is expected that the whole design
Francesco LEE. Mitchell, Joyce A., “Electronic
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