A SMART MEDICINE MANAGER DELIVERING HEALTH CARE

TO THE NETWORKED HOME AND BEYOND

An Overview of the iCabiNET System

Martín López-Nores, José J. Pazos-Arias, Jorge García-Duque and Yolanda Blanco-Fernández

Department of Telematics Engineering, University of Vigo, Spain

Keywords:

Remote health care, smart medicine packaging, residential networks, semantic reasoning.

Abstract:

Misuse of prescription and over-the-counter drugs is a growing problem that impinges heavily on the well-

being of people and the economics of public health systems. Most commonly, misuses arise from forgetfulness

or lack of information about drugs and their interactions, hence there is much place for solutions to automati-

cally monitor medicine intake, issue reminders and deliver medical advice. This paper presents a system that

accomplishes these tasks by harnessing recent advances in smart medicine packaging, residential networks

and semantic reasoning. Such a combination yields a medicine manager featuring great precision in drug

monitoring, plus unprecedented capabilities to reach the users and provide them with valuable information.

1 INTRODUCTION

Recent statistics reveal that the misuse of prescrip-

tion and over-the-counter drugs is becoming a major

problem as life expectancy increases and the range

of medications grows, to the point of being as dan-

gerous and costly as many illnesses (Sullivan et al.,

1990; Downey et al., 2000). To ground this signiﬁ-

cance in numbers, consider the following USA facts,

retrieved from (American Heart Association, 2007;

Akram, 2000; Ofﬁce of Applied Studies, 2005):

• 50% of ﬁlled prescriptions are taken incorrectly.

In the worst extreme, 65% of the elderly fail to

comply with their medication regimens, with 26%

of those errors being potentially serious.

• 23% of nursing home admissions are due to abuse

or non-compliance, costing $31.3 billion per year

and affecting 380,000 people. The same happens

with 10% of hospital admissions, costing $15.2

billion and affecting 3.5 million people.

• $75 billion are annually spent on preventable hos-

pitalizations due to medication misuse, plus other

$30 billion on additional medications prescribed

after non-compliance.

• 125,000 deaths occur annually due to drug inter-

actions.

As noted in (Hughes et al., 2001; MedPrompt,

2007), misuses typically arise from forgetfulness or

lack of information about the different drugs avail-

able. This has raised enormous interest in developing

solutions to automatically monitor medicine intake,

issue reminders and deliver medical advice (Bricon-

Souf and Newman, 2007). Some precedents for this

idea can be found in (Wan, 1999; Ho et al., 2005),

with embedded systems that employed RFID

de-

vices to recognize medicaments and weighing scales

to guess the doses available. However, those systems

are impractical due to the following drawbacks:

• The weighing scales require the users to pick one

medicament at a time and put it back before pick-

ing another. This is a cumbersome discipline to

follow in many cases, entailing a clear risk of

monitoring imprecision.

• The means available to reach the users are very

limited, merely consisting of embedded screens,

lights or alarms. Thus, it is not possible to pre-

vent forgetfulness if the user happens to be out of

home, or simply in a room where he/she cannot

see the lights or hear the alarms.

• Finally, the previous systems rely on the assump-

tion that people use a medicine cabinet as the

RFID: Radio Frequency IDentiﬁcation.

167

opez-Nores M., J. Pazos-Arias J., Garc

ıa-Duque J. and Blanco-Fern

andez Y. (2008).

A SMART MEDICINE MANAGER DELIVERING HEALTH CARE TO THE NETWORKED HOME AND BEYOND - An Overview of the iCabiNET System.

In Proceedings of the First International Conference on Health Informatics, pages 167-172

 SciTePress

only place for medication keeping. Nevertheless,

polling data reveals that this may not be true in

as many as 90% of the cases, as people tend to

store their medicines in various places around the

house (Fishkin and Consolvo, 2003).

With these problems in mind, we introduce in this

paper a system, called the iCabiNET, that tackles the

aforementioned issues by integrating recent advances

in various areas of research. The basic ideas behind

this system are explained in the overviewof Section 2.

After that, Section 3 describes two usage scenarios

to illustrate the beneﬁts and the potential uses of our

approach. Section 4 provides technical details of an

implementation capable of realizing those scenarios.

Finally, Section 5 includes a summary of conclusions

and motivates future work.

2 SYSTEM OVERVIEW

As shown in Fig. 1, we have conceived the iCabiNET

as a new element of a residential network, ready to

communicate directly with other appliances installed

in a house, and with the outside world through a res-

idential gateway. Within this setting, the operation of

the system consists of two major steps, to be detailed

in the following subsections:

• Gathering information about available drugs and

doses.

• Processing that information to identify and react

to actual or potential misuses.

2.1 Gathering Information

In what concerns the gathering of information about

available medicines and doses, the iCabiNET can

coexist with any of the previous monitoring so-

lutions (Wan, 1999; Floerkemeier and Siegemund,

2003; Ho et al., 2005), given that they propagate

data over the residential network. Furthermore, we

have introduced support for the smart packagingtech-

nologies currently promoted by stakeholders of the

pharmaceutical industry. As explained in (Goodrich,

2006; Harrop, 2006), the idea is to integrate RFID

devices and different types of sensors with the pack-

aging of the medicines, to allow tracking not only

medicine names, but also the doses available with no

additional equipment. A common example is that

of smart blister packs, which record the removal of

a tablet simply by breaking an electric ﬂow into the

RFID’s integrated circuit; other possibilities exist for

liquid medicines, ointments and so on.

Figure 1: The iCabiNET system in a residential network.

Smart packaging enables the iCabinet to monitor

the intake of drugs from anywhere, with the highest

precision, with no need to keep all drugs in a unique

place, and with no risk of mistaking one drug for

another. The system simply gathers information by

polling RFID readers deployed around the house (the

RR devices in Fig. 1) or connected to the residential

network from other places (e.g. from the ofﬁce).

2.2 Reacting to Misuses

Primarily, the iCabiNET is intended to enforce some

medication guidelines, such as “

the user should take

one of these tablets every 4 to 6 hours

”. Accordingly,

in the operational scheme of the system (see Fig. 2),

there is a ‘Watchdog’ module devoted to continually

supervising the information gathered about available

medicines and doses, to check that the former remain

in good condition and the latter decrease correctly

with time. This module detects odd circumstances

driven by rules that may involve user conditions (like

age, gender or previous diseases), and notiﬁes those

circumstances by triggering different types of events.

The events are the input for a second module, the

‘Actuator’, to decide what actions will be performed

to issue warnings or deliver health care information to

the user. This module ﬁrstly considers generic state-

Figure 2: The operational scheme of the iCabiNET.

ments with no liaison to speciﬁc appliances, such as

those of Table 1. Then, it instantiates those statements

on demand, using the appliances it ﬁnds most conve-

nient. In doing so, the ‘Actuator’ takes into account

data from the user’s proﬁle, contextual information

provided by external devices (e.g. about whether the

user is sleeping, watching TV or out of home) and

descriptions stored in a network registry of the ap-

pliances connected to the residential network and the

operations they can do.

Thus, for example, a “

warn

the user

” action can be automatically made to trig-

ger an alarm clock, to interrupt a TV program and

display some message on screen, or to make a tele-

phone call. The enormous range of possibilities en-

abled by the residential network to reach the user is

precisely the point that makes the iCabiNET most ad-

vantageous with regard to previous systems.

Orchestrating appliances as explained above re-

quires the iCabiNET to take a great number of de-

cisions that cannot be determined beforehand. No-

ticeably, this intelligence is not catered for by the cur-

rent residential network standards (Baxter, 2005), be-

cause they merely provide for executing pre-compiled

programs (usually referred to as bundles). Thus, it

would be necessary to write different versions of the

same behavior for all the possible conﬁgurations of

devices in and out of home, even considering the dif-

ferent ways to invoke the same operations for appli-

ances assembled by different manufacturers. Such an

approach would obviously exhibit limited ﬂexibility

The registry can reside in the iCabiNET or in any other

device permanently connected to the residential network,

most typically the residential gateway.

Table 1: Some events types and actions they might trigger.

Event Action

Oblivion “

Wait up to 90 minutes before

reminding the user

”

Expiration “

Deliver increasingly serious

warnings day after day

”

Depletion “

Arrange an appointment with

the doctor to get a new pre-

scription

”

Interaction “

Recommend an innocuous

combination of drugs with the

same effects

”

Discontinuation “

Restart the medication at a

lower dose

”

Abuse “

Warn the local authorities

”

and severe scalability problems. The iCabiNET’s so-

lution to these questions builds upon two main ideas:

• The ﬁrst idea is to deliver virtual bundles contain-

ing no implementation, but rather process ﬂows

that arrange medication guidelines, user condi-

tions, rules, events and generic actions in semi-

formal constructs.

• The second idea is to enhance the network registry

with mechanisms from the Semantic Web (Anto-

niou and van Harmelen, 2004), using ontologies

as unique conceptualizations of what the different

appliances can do and how: operations, input and

output parameters, quality attributes, etc.

As shown in Fig. 3, when a virtual bundle appears

in the system, the iCabiNET creates one implementa-

tion bundle to supervise the occurrence of events in

the corresponding process ﬂow. Then, when it is time

to perform some actions, the implementation bun-

dle uses matching techniques like those of (Paolucci

et al., 2002; Fujii and Suda, 2005) to ﬁnd the most

suitable appliances at the moment (A, B, D and E in

Fig. 3) and start invoking their operations in the spec-

iﬁed order. This approach promotes openness and in-

teroperability, making it possible to deliver the same

virtual bundles to everybody, regardless of the par-

ticular appliances owned by each user. Furthermore,

nothing has to be re-programmed when any element

changes, and it is even possible to incorporate newly-

invented devices and functionalities with a simple up-

date of the ontologies.

Following the commented scheme, several virtual

bundles are preloaded in the iCabiNET to deal with

common tasks, such as checking interactions between

available drugs by accessing remote data bases, or

downloading process ﬂows to drive the monitoring of

new drugs acquired by the user. Other virtual bundles

Figure 3: Activating appliances from virtual bundles.

can be entered by the user or by authorized external

entities, like health institutions (they know what the

user needs) or pharmaceutical companies (they know

the best way to take their products).

3 USAGE SCENARIOS

Having explained the essentials of the iCabiNET, we

now describe two usage scenarios to illustrate the

range of functionalities it can deliver. The technolo-

gies employed to make these scenarios possible are

described in Section 4.

3.1 Scenario #1

Ann is having breakfast before going to work, and

switches on the radio to hear the ﬁrst news of the

day. When she is about to turn off the apparatus, the

iCabiNET reminds her of the medicines she should

carry, playing a pre-recorded message. Later, follow-

ing the prescription issued by the doctor (loaded into

the iCabiNET directly from the health center), Ann

receives an SMS message in her mobile phone every

three hours to remember taking her drugs. At the end

of the day, when Ann is back in her house, the iCab-

iNET attempts to check that the available doses have

decreased as expected, but it turns out that Ann has

left them behind. In this case, the iCabiNET rings the

in-home telephone to ask Ann whether she has taken

the medicines correctly; she replies afﬁrmatively by

pressing the asterisk key. During the night, the alarm

clock in Ann’s bedroom will be responsible for wak-

ing her up when it is time for new doses.

3.2 Scenario #2

While having a walk outside, Bob decides to buy an

over-the-counter drug to treat his allergy to pollen.

Afterwards, when he enters his house, the iCabiNET

records the tablets he has bought, and automatically

downloads medication guidelines for adults from the

manufacturer. A few days later, Bob is watching TV

in the living room. When it is time to take a pill, the

iCabiNET pops up a reminder on the screen, indicat-

ing the drug’s commercial name, a photograph of its

packaging and the recommended dose. For the best

comfort, the system starts ﬂashing the lights of the

room where Bob had left the tablets the last time he

took one. As Bob takes a new dose, the iCabiNET

ﬁnds that the pills are running out; so, when he sits

back in the sofa, he is faced with an interactive TV

application that he can use to buy new supplies from

an online drugstore. Bob uses the remote control to

enter shipping and payment details, and takes the op-

portunity to buy some throat lozenges he likes.

4 PROTOTYPE

IMPLEMENTATION

In order to assess the feasibility of the approach de-

scribed in Section 2, we have developed and tested

a prototype of the iCabiNET taking the scenarios of

Section 3 as a reference of the functionalities it should

provide. It is worth noting that the system needs not

be a standalone device, hence we built it as a software

package to run on any device that is permanently con-

nected to a residential network. Within this perspec-

tive, we strove to employ standard technologies and

open-source software packages.

As the basis for our implementation, we chose the

frameworkproposed by OSGi (OSGi Alliance, 2005),

which is nowadays the most popular standard for res-

idential networks. This platform is advantageous for

various reasons: (i) it supports different widespread

protocols for secure and non-secure communication

among appliances in home and outside, (ii) it deﬁnes

a cooperative model where appliances can dynami-

cally discover and invoke the operations provided by

others, and (iii) it enables remote management of the

appliances and the operations they provide. From

among other possibilities, we implemented the iCab-

iNET as an OSGi bundle using the open software

packages from the OSCAR

project, because they are

particularly well documented.

Just like the other residential network standards,

OSGi provides no support for orchestrating appli-

ances according to virtual bundles as described in

Section 2.2. To this aim, inspired by the work

of (Slomiski, 2006), we opted to borrow solutions

from the most mature related ﬁeld of research: Web

Services. Therefore, we express the process ﬂows us-

ing the BPEL language (Juric, 2006), which provides

constructs to describe arbitrarily complex processes,

focusing on the invocation of operations and the ﬂow

of control between them. There are many tools sup-

porting this language, offering plenty of facilities to

create, edit and execute process ﬂows. We have devel-

oped the core of the iCabiNET over the ActiveBPEL

engine, introducing the following enhancements:

• The BPEL ﬂows can include declarative rules

written in Jess

to drive the generation of events

related to the intake of medicines. Accordingly,

the ‘Watchdog’ module of Fig. 2 incorporates a

Jess execution environment, which is the only

protected part of our implementation —it is only

free for academic purposes.

• The actions in the BPEL ﬂows include concepts

of the SOUPA and GUMO ontologies presented

in (Chen et al., 2004; Heckmann et al., 2005),

which are also used in a semantic registry main-

tained by the iCabiNET itself. With those bases,

plus the context-aware features of (Gu et al.,

2004; Zhang et al., 2005), the ‘Actuator’ mod-

ule of Fig. 2 uses the Protégé OWL API

to apply

the same semantic matching mechanisms we de-

signed for (Díaz-Redondo et al., ress) —the rea-

soning abilities are not linked to any speciﬁc do-

main of application.

As regards the interactive applications presented

to the user to realize actions in the virtual bundles

(e.g. the online drugstore of Scenario #2), the au-

thors of (Ramos-Cabrer et al., 2006) proposed a way

to merge OSGi with the MHP standard of applications

for Digital TV (Digital Video Broadcasting, 2003).

We have extended those mechanisms to support ap-

plications for PCs and mobile devices as well, and to

handle descriptions of those applications also in terms

of the SOUPA and GUMO ontologies.

http://oscar.objectweb.org

http://www.activebpel.org

http://herzberg.ca.sandia.gov/jess

http://protege.stanford.edu

All the code aforementioned pieces of the iCab-

iNET are written in Java, and so we used this lan-

guage for the code to glue those elements together.

That code was executed by a J2ME virtual machine

running on a residential gateway. Out of the iCabi-

NET itself, in what concerns the gathering of infor-

mation about the availability and intake of medicines,

we completed the settings for our trials with purpose-

built smart blister packs, because smart packaging

technology is not yet available in retail drugs (only

in clinical trials). Besides, we developed our own

RFID readers for those blister packs, since we did not

ﬁnd suitable alternatives in the market ready to work

within an OSGi network.

5 CONCLUSIONS

Technology may be an important aid to ﬁght the wor-

risome health problems and the increasing economic

costs due to the misuse of prescription and over-the-

counter drugs. With this vision in mind, we have de-

signed and implemented the iCabiNET system, which

is the ﬁrst outcome of a multidisciplinary research ef-

fort to put technology to the service of better medica-

ment monitoring and management.

The iCabiNET can be regarded as a powerful ex-

tension of previously-existing solutions to monitor

medicine intake (e.g. the embedded systems of (Wan,

1999; Floerkemeier and Siegemund, 2003; Ho et al.,

2005)), introducing the ability to issue warnings and

deliver medical advice using any appliance connected

to a residential network. Eventually, when the smart

packaging technologies ﬁnally take up the market,

the iCabiNET approach will actually replace that of

previous systems, providing the greatest ﬂexibility

and precision in monitoring, limitless possibilities to

reach the user using whichever technological means,

and unprecedented capabilities to interact with health

institutions, drug manufacturers and retailers.

Also, the iCabiNET can be seen as introducing

support to monitor the intake of drugs in previously-

existing platforms to provide health care information

through Internet-enabled personal computers (Roine

et al., 2001), Digital TV (Simonov et al., 2007) or

mobile devices (Komninos and Stamou, 2006). In

this regard, we can emphasize the integrated and

technology-neutral solution achieved with the seman-

tic reasoning features, which render an open environ-

ment with feasible and scalable exploitation models.

ACKNOWLEDGEMENTS

This work has been supported by the Spanish Min-

istry of Education and Science (Project TSI2007-

61599).

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