Treatment regimen compliance and efficacy with feedback

A method and system for interaction with a community of individuals, relating to compliance with a treatment regimen. Individuals interact with a protocol or intelligent message to provide assistance in all aspects of treatment regimen compliance, data collection, supply, review and modification.

These applications are each hereby incorporated by reference as if fully 
set forth herein. These applications are collectively referred to herein 
as "incorporated disclosures." 
BACKGROUND OF THE INVENTION 
1. Field of the Invention 
This invention relates to interaction with a community of individuals, 
relating to treatment regimen compliance and efficacy, including supply 
and use of pharmaceuticals. 
2. Related Art 
When medical personnel prescribe treatment regimens for patients or 
"patients" undertake non-prescription treatment regimens (whether such 
regimens are prescribed or undertaken for medication, physical therapy, 
psychological therapy, self-improvement, or other purposes), a problem can 
arise in assuring that the patients comply with the requirements of the 
treatment regimen. For example, some patients are disorganized, forgetful, 
or simply unwilling to comply. When the treatment regimen has potential 
side effects, or when the treatment regimen is to be followed under stated 
conditions (for example: taking medicine with meals, not with alcohol, or 
in the evening), patient compliance can be relatively reduced even 
further. When the treatment regimen is relatively complex, some patients 
are even unable or unwilling to manage that treatment regimen. 
Known methods for monitoring and controlling treatment regimens are 
relatively costly and limited in capability. Some known methods are 
described in the following patents: 
U.S. Pat. No. 5,408,443, "Programmable Medication Dispensing System," 
issued Apr. 18, 1995 in the name of Edward D. Weinberger. 
U.S. Pat. No. 5,642,731, "Method of and Apparatus for Monitoring the 
Management of Disease," issued Jul. 1, 1997 in the name of Bruce A. Kehr. 
U.S. Pat. No. 5,752,235, "Electronic Medication Monitoring and Dispensing 
Method," issued May 12, 1998 in the name of Bruce A. Kehr, et al. 
While these known methods generally achieve the goal of monitoring and 
controlling a treatment regimen, particularly a medication regimen, they 
suffer from several drawbacks and limitations. 
First, there is a need to provide a portable system to monitor and 
encourage compliance, and facilitate data collection, so that patients are 
restricted as little as possible regarding their activities and movements. 
Second, there is a need to determine if patients are actually complying 
with treatment regimens at times when the patients are relatively remote 
to client devices for the system. Known methods do not provide adequate 
feedback to determine whether patients are complying with the treatment 
regimen unless they remain relatively local to client devices. 
Third, there is a need to determine whether treatment regimens have the 
desired and intended effects. Known methods do not provide adequate 
feedback to determine whether treatment regimens are effective, or whether 
patients are suffering any untoward side effects. Using known methods, 
medical personnel must generally wait for patients to complain, or for 
medical tests to show, that prescribed treatment regimens are inadequate 
or are producing side effects. Similarly, using known methods, patients 
undertaking non-prescribed treatment regimens generally do not have 
effective or convenient systems to monitor and record whether 
non-prescribed treatment regimens are producing intended results. 
Fourth, there is a need to inform patients to follow treatment regimens, 
particularly when patients are forgetful or treatment regimens are 
complex. Although known methods do include reminders to patients, it would 
be advantageous to tailor those reminders to patients' actual compliance 
history (thus, providing fewer reminders when they are relatively less 
necessary and more reminders when they are relatively more necessary). 
Fifth, there is a need to leverage expert knowledge to improve response to 
feedback from patients, and to reduce the time and expense required for' 
medical personnel to individually monitor, evaluate and modify treatment 
regimens. 
Sixth, there is a need to broaden application of reminder and expert 
knowledge leveraging systems beyond medication regimens, to include 
physical, psychological, self-improvement and other treatment regimens. 
Accordingly, it would be advantageous to provide a portable device that can 
be coupled and uncoupled to a communication system with feedback to 
monitor patient compliance with, and effectiveness of, treatment regimens, 
so that input from patients regarding treatment regimens can be recorded, 
reviewed, analyzed and otherwise generally acted upon. Medical personnel 
and/or patients can thus (1) monitor compliance with treatment regimens, 
(2) monitor effectiveness or side effects of treatment regimens, (3) 
remind patients no more than necessary, and (4) possibly alter treatment 
regimens in response to feedback from patients. These advantages are 
achieved in embodiments of the invention in which a portable device is 
intermittently coupled to a client device in a client-server system, the 
patient enters information to the portable device about following the 
treatment regimen while the portable device is uncoupled, and medical 
personnel or the patient can receive that information and possibly alter 
the behavior of the portable device when the portable device is re-coupled 
to the system. 
SUMMARY OF THE INVENTION 
The invention provides a method and system for interaction with a community 
of individuals, relating to compliance with and effectiveness of treatment 
regimens, including supply and use of pharmaceuticals, using a protocol or 
other intelligent message which acts in place of a service provider and 
which is capable of collecting or imparting information to patients in 
place thereof. Individuals interact with the protocol or intelligent 
message to provide assistance in all aspects of treatment regimen 
compliance, data collection, supply or delivery, review and modification. 
These aspects can include (1) reminders regarding compliance with a 
selected treatment regimen for medication, physical therapy, psychological 
therapy, self-improvement, or some combination thereof, (2) data 
collection of facts regarding patient compliance, symptomology, possible 
drug interactions or side effects of medication if required by the 
treatment regimen, and other facts relevant to evaluation and possible 
modification of the treatment regimen; (3) networked integration with 
workstations for medical professionals to automate approvals and 
modifications, and refills and delivery of medication if required by the 
treatment regimen. 
A system includes a set of client devices and a server device. A service 
provider determines a treatment regimen for selected patients, determines 
a protocol to be followed by the client devices to assist the patient in 
complying with that treatment regimen [in assisting with that medication 
regimen] and to maximize effectiveness of treatment, and sends that 
protocol to the server device. The server device can update (responsive to 
the protocol) selected instructions at the client devices, and can receive 
(responsive to selected instructions) information from the client devices 
regarding their associated patients. 
In a first preferred embodiment, a client device, located locally to a 
patient, couples to a portable device (such as a cellular telephone, 
pager, "Palm Pilot" or other handheld computer, or watch), capable of 
being carried away by the patient to locations relatively remote from the 
client device. The client device can interact with the portable device: 
(1) to provide the portable device with the capability of reminding the 
patient regarding the treatment regimen, or (2) to provide the portable 
device with the capability of further data collection regarding the 
patient. The client device can interact with the portable device using a 
docking connection, an infrared connection, a radio-frequency connection, 
a plug-in connection, or another suitable connection.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
In the following description, a preferred embodiment of the invention is 
described with regard to preferred process steps and data structures. 
Embodiments of the invention can be implemented using general purpose 
processors or special purpose processors operating under program control, 
or other circuits, adapted to particular process steps and data structures 
described herein. Implementation of the process steps and data structures 
described herein would not require undue experimentation or further 
invention. 
System Elements 
FIG. 1 shows a block diagram of a system 100 to encourage and monitor 
compliance with a treatment regimen using a protocol or other intelligent 
message which acts in place of a service provider to collect and impart 
information relevant to the treatment regimen, including a patient device 
110, a pharmacist device 140, a medical professional device 150, and a 
server device 160, said devices being coupled using a communication 
network 130, and a portable device 112 which can be coupled to the patient 
device 110 to receive information regarding the treatment regimen and send 
feedback from the patient 111 responsive thereto. 
For further information regarding a data structure and simplified patient 
interaction interface, and preferred embodiments of the patient device 
110, pharmacist device 140, medical professional device 150, and the 
server device 160 including database 161 of treatment regimen information, 
see related application Ser. No. 09/210,323, Express Mail Mailing No. 
EE143637591US, filed Nov. 30, 1998, in the name of Stephen J. Brown, 
titled "Leveraging Interaction with A Community of Individuals," assigned 
to the same assignee, attorney docket number HHN-007, and other related 
applications incorporated by reference therein. 
For further information regarding the protocol or other intelligent message 
used by the system, see related application Ser. No. 09/203,882, Express 
Mail Mailing No. EE143637565US, filed Dec. 1, 1998, in the name of Stephen 
J. Brown, titled "Remote User Data Collection Protocols Including Data 
Structures and User Interface," assigned to the same assignee, attorney 
docket number HHN-002, and other related applications incorporated by 
reference therein. 
For further information regarding a medicine dispenser which can be used by 
the system, see related application Ser. No. 09/203,880, Express Mail 
Mailing No. EE143637557US, filed Dec. 1, 1998, in the name of Stephen J. 
Brown, et al., titled "Using A Computer Communication System With Feedback 
to Dispense Medicine," assigned to the same assignee, attorney docket 
number HHN-005, and other related applications incorporated by reference 
therein. 
Portable Device 
FIG. 3 shows a first preferred embodiment of a portable device 112 used by 
the system 100. 
In a first preferred embodiment, the portable device 112 includes a 
coupling element 113 for coupling the portable device 112 to the patient 
device 110, a memory element 114, a processor chip 115 including a clock 
circuit 116, a presentation element 117, and a patient feedback input 
element 118. 
A service provider determines a treatment regimen for selected patients 111 
and a protocol to be followed by their portable devices 112 to assist the 
patients 111 in following the treatment regimen. The service provider 
sends the treatment regimen and protocol to the server device 160 where it 
is recorded in the database 161. The server device 160 sends the treatment 
regimen and protocol information to the patient device 110, and optionally 
to the pharmacist device 140 and the medical professional device 150. 
The portable device 112 is coupled to the patient device 1 10 using the 
coupling element 113. The coupling element 113 may couple using a docking 
station, an infrared connection, a radio-frequency connection, a plug-in 
connection, other suitable means or any variant thereof 
While coupled, the treatment regimen and protocol information received by 
the patient device 110 is sent to the portable device 112 and recorded in 
the memory 114. In a first preferred embodiment, the power source 119 is 
rechargeable and the charge can be replenished by the patient device 110 
while the portable device 112 is coupled to it. In alternative 
embodiments, the power source 119 is rechargeable and the charge can be 
replenished by some other device, or includes one or more disposable 
batteries. 
After the treatment regimen and protocol information is recorded in the 
memory 114, the portable device 112 can be uncoupled from the patient 
device 110 and taken with the patient 110 to locations relatively or 
logically remote from the patient device 110. Whether the portable device 
112 coupled or uncoupled to the patient device 110, when the patient 111 
is due to perform an act according to the treatment regimen, the portable 
device 112 uses the presentation element 117 to provide a reminder message 
instructing the patient 111 to perform that act. In a first preferred 
embodiment, the act to be performed is related to compliance with a 
medication regimen including, without limitation, obtaining medicine, 
taking medicine, taking medicine with another substance such as food or 
water, not taking medicine with another substance such as alcohol or 
incompatible medications, or obtaining a prescription refill. In 
alternative embodiments, the act to be performed may be pursuant to a 
physical therapy regimen including, without limitation, exercising, 
stretching, changing position, or changing work routine; pursuant to a 
psychological therapy regimen including, without limitation, repeating an 
affirmation, meditation, self-hypnosis or other mental activity; or 
pursuant to a self-help regimen or other type of treatment regimen such as 
weight loss including, without limitation, drinking water or eating a 
snack. 
The patient 111 performs the indicated act and enters a message into the 
portable device 112 confirming performance of the act using the patient 
feedback input element 118. Operation of the patient feedback input 
element 118 causes the processor chip 115 to cancel the reminder message, 
check the clock 116, and record the time and fact of performance in the 
memory 114. In a first preferred embodiment, the patient 111 also enters 
additional information relevant to monitoring and evaluating the treatment 
regimen in response to queries by the presentation element 117 in 
accordance with the treatment regimen and protocol. 
The number of reminder messages provided to the patient 111, and the number 
of messages from the patient 111 confirming performance of the indicated 
acts and/or providing other information relevant to compliance with and 
effectiveness of the treatment regimen, is limited only by the memory 
capacity of the portable device 112. 
In a first preferred embodiment, the presentation element 117 is a 
human-readable visual display using LCD's, LED's, or other suitable 
devices. In alternative preferred embodiments, the presentation element 
117 can be a device which produces human-intelligible sound, or a 
combination of devices which produce human-intelligible visual and audible 
signals. 
At some later time, the portable device 112 is re-coupled to the patient 
device 110 using the coupling element 113, causing the contents of the 
memory 114 to be downloaded into the patient device 110 and sent to the 
server device 160 for recording in the database 161. Such a time may be as 
is convenient to the patient 111, or according to a selected maximum time 
interval dictated by the treatment regimen and protocol, or as is required 
to replenish the power source 119 of the portable device 112, or in 
accordance with other requirements of the system 100. 
At the server device 160, the protocol or other intelligent message reviews 
and compares the information provided by the patient 111 to the 
requirements of the treatment regimen in order to evaluate the 
effectiveness of the treatment regimen towards achieving treatment 
objectives and as to compliance of the patient 111 with the treatment 
regimen. The protocol may then leave the treatment regimen unchanged or 
modify it as needed to increase effectiveness and/or compliance; in either 
case, the server device 160 sends a message to the patient device 110 as 
to the regimen to be followed from that time forward. In a preferred 
embodiment, the server device 160 also sends that message to the 
pharmacist device 140 and the medical professional device 150. For 
additional information regarding the protocol used by the system 100 and 
interaction of the protocol with other elements of the system 100, see 
discussion above at System Elements regarding related applications. 
In a first preferred embodiment, information regarding the entire course of 
the treatment regimen, such as each updated regimen and its effectiveness 
and relative compliance by the patient can be stored by each of those 
devices and displayed on demand. In alternative embodiments, only the 
server records the entire course, or only selected devices, or some 
combination thereof. 
In a preferred embodiment, when a treatment regimen requires a patient 111 
to take one or more medications, the portable device 112 can be coupled to 
a medication dispenser containing medication specified by the treatment 
regimen. In an alternative embodiment, the portable device 112 also 
controls the medication dispenser so as to release only the correct dosage 
of the correct medication at the correct time responsive to the treatment 
regimen. In a further alternative preferred embodiment, the dispenser 
automatically provides feedback to the portable device 112 when the 
correct medication is removed, canceling the reminder message and storing 
the feedback for subsequent downloading to the patient device 110 on the 
next occasion that the portable device 112 is coupled to the patient 
device 110. 
The patient device 110 can be any device for electronic communication 
including, but not limited to, an application specific device, a 
hard-wired telephone, a cellular telephone, a pager, a personal desktop 
computer, a personal notebook computer, a hand-held computing device, an 
internet appliance, an internet-enabled television such as WebTV, personal 
digital assistant such as the Palm III, or any variant thereof. 
The portable device 112 can be any portable device for electronic 
communication which is capable of being coupled to the patient device 110 
including, without limitation, an application specific device, a cellular 
telephone, a pager, a personal notebook computer, a hand-held computing 
device, an internet appliance, a personal digital assistant such as the 
Palm III, a watch, or any variant thereof. 
The feedback input element 118 can be any means of providing input to an 
electronic communication device including, but not limited to, a button, a 
telephone key, a computer keyboard key, a voice-response activator, or any 
variant or combination thereof. 
Method of Operation 
FIG. 2 shows a process flow diagram of a method for operating a system for 
leveraging expert interaction with a community of individuals to encourage 
compliance with a treatment regimen and for collecting and imparting 
information relevant to that treatment regimen. 
A method 200 is performed by the system 100, as follows: 
At a flow point 201, the system 100 is ready to proceed. 
At a step 202, a service provider enters information concerning a treatment 
regimen and protocol to be followed by the patient 111. 
At a step 203, the treatment regimen and protocol information is sent to 
the server device 160 using the communications network 130. 
At a step 204, the server device 160 records the treatment regimen and 
protocol information received from the service provider in the database 
161. 
At a step 205 in a preferred embodiment, the server device 160 sends the 
treatment regimen and protocol information to the patient device 110, the 
pharmacist device 140 and the medical professional device 150 using the 
communication network 130. In alternative embodiments, the server device 
160 may send the treatment regimen and protocol information only to the 
patient device 110. 
At a step 206, the portable device 112 is coupled to the patient device 110 
and the treatment regimen and protocol information is copied into the 
memory 114 of the portable device 112. 
At a step 207, the portable device 112 is uncoupled from the patient device 
110 and is taken with the patient 111 to a location relatively remote from 
the patient device 110. 
At a step 208, responsive to the treatment regimen and protocol information 
stored in the memory 114 in conjunction with input from the clock 116, the 
patient device 110 uses the presentation element 117 to provide a reminder 
message to the patient 111 that an act is required to be performed by the 
patient 111 and instructs the patient 111 regarding the act to be 
performed. 
At a step 209, the patient 111 performs the indicated act as directed. 
At a step 210, the patient 111 operates the feedback input element 118 on 
the portable device 112, canceling the reminder message. 
At a step 211, the portable device 112 uses the presentation element 117 to 
query the patient 111 to provide information responsive to the protocol 
for evaluating the effectiveness of the treatment regimen. 
At a step 212, the patient 111 operates the feedback input element 117 to 
provide information responsive to the queries, and that information is 
recorded in the memory 114. 
At a step 213, the portable device 112 is re-coupled to the patient device 
110. 
At a step 214, the information stored in the memory 114 is sent to the 
patient device 110, which in turn sends that information to the server 
device 160 using the communication network 130. 
At a step 215, the information received by the server device 160 is 
recorded in the database 161. 
At a step 216, in a preferred embodiment the server device 160 sends the 
information received from the patient device 110 to the pharmacist device 
140 and to the medical professional device 150 using the communication 
network 130. In an alternative embodiment, the server device 160 does not 
send the information received from the patient device 110 to the 
pharmacist device 140 or to the medical professional device 150, whether 
using the communication network 130 or otherwise. 
At a step 217, the information received by the server device 160 from the 
patient device 110 is evaluated by the protocol. 
At a step 218, the protocol updates the treatment regimen and either leaves 
it unchanged or modifies it in accordance with the protocol logic. 
At a step 219 in a preferred embodiment, the server device 160 sends the 
updated treatment regimen information to the patient device 110, to the 
pharmacist device 140 and to the medical professional device 150, using 
the communication network 130. In an alternative embodiment, the server 
device 160 does not sent the updated treatment regimen information to the 
pharmacist device 140 or the medical professional device 150. 
At a step 220 in a preferred embodiment, the pharmacist 141 and/or the 
medical professional 151 review and compare the original treatment 
regimen, the compliance and other information input by the patient 111, 
and the updated treatment regimen, and either leave the updated treatment 
regimen and protocol information unchanged or modify it as necessary. In 
an alternative embodiment, step 220 does not take place. 
At a step 221 in a preferred embodiment, the treatment regimen and protocol 
information as unchanged or as modified by the pharmacist 141 and/or the 
medical professional 151 is sent to the server device 160 using the 
communication network 130. In an alternative embodiment, step 221 does not 
take place. 
At a step 222, the server device 160 records the treatment regimen and 
protocol information as unchanged or as modified by the pharmacist 141 
and/or the medical professional 151 in the database 161. In an alternative 
embodiment, step 222 does not take place. 
At a step 223 in a preferred embodiment, the server device 160 sends the 
treatment regimen and protocol information as unchanged or as modified by 
the pharmacist 141 and/or the medical professional 151 to the patient 
device 110 using the communication network 130. In an alternative 
embodiment, step 223 does not take place. 
At a step 224, the patient device 110 sends the updated treatment regimen 
information to the portable device 112 and it is recorded in the memory 
114. 
At a step 225, the patient device 110 replenishes the charge of the power 
source 119. 
At a step 226, the patient 111 uncouples the portable device 112 from the 
patient device 110. 
At a step 227, the pharmacist 141 provides a refill or new medicine to the 
patient 111 responsive to the treatment regimen and protocol infortmation. 
In an alternative embodiment, step 227 does not take place. 
Alternative Embodiments 
Although preferred embodiments are disclosed herein, many variations are 
possible which remain within the concept, scope, and spirit of the 
invention, and these variations would become clear to those skilled in the 
art after perusal of this application.