Remote patient monitoring system with garment and automated medication dispenser

The invention provides an integrated remote patient monitoring system that includes a garment, a monitoring device, and a medication dispensing unit. The garment is adapted for wearing by a patient, and is adapted to house at least one sensor that is in communication with the patient's body. The garment includes a connector communicating with the sensor. The monitoring device communicates with the sensor through the connector, and is configured to record signals from the sensor. The monitoring device is also configured to exchange signals representing patient status with a central station. The medication dispensing unit communicates with the monitoring device to receive commands from the monitoring device, and to transfer signals representing the status of medication doses to the monitoring device.

FIELD OF THE INVENTION

This invention pertains generally to patient monitoring, and more specifically to monitoring patient status and communicating with a patient from a point remote from the patient's location.

BACKGROUND OF THE DISCLOSURE

An ongoing concern in the medical profession is the containment of labor costs, especially the cost of nursing and other patient monitoring personnel. One way to minimize costs is to find ways to allow fewer nurses to monitor larger numbers of patients without jeopardizing patient safety. In addition, hospitals are discharging patients earlier, allowing them to recuperate at home rather than in the hospital. In a typical hospital setting, nurses must periodically check the patients' vital signs, to administer doses of medicine, and to attend to requests or problems reported by patients. Where patients are recuperating at home or in far-flung branches of a large hospital, however, it is especially difficult for nursing personnel to monitor those remote patients in a cost-effective manner.

Another concern in the medical profession is the accurate administration of prescription medication to patients. Typically, prescription medicine is administered at periodic dosing intervals during a day. These dosing intervals are determined by a dosing schedule established by a treating physician. Medical support personnel administer doses of medication by retrieving the prescribed doses from bulk medicine supplies at the hospital pharmacy. This approach is inefficient and error-prone, because the support personnel often split time between administering medication and performing other duties. Further, to the extent that records of medication doses are kept, those records of medication doses are kept manually by the support personnel themselves. If the personnel are hurried, they may not keep accurate records of medication doses. In addition, the medication doses may not be correct because a harried support person failed to fill the prescription properly.

Yet another concern is the precise placement of the various sensors used to sense a patient's vital signs through physical contact with the patient's body. For example, an EKG sensor operates by sensing electrical activity within the body, and must be placed strategically on the body best to detect this electrical activity. Similarly, other types of sensors must be placed carefully and precisely for optimum sensing effectiveness. In the context of remote patient monitoring, it is desirable to avoid requiring medical support personnel to travel to the patient's location to place and check the various sensors located on a patient's body. Imposing the expense of such travel on medical support personnel could outweigh any benefits realized by having the patient recuperate at a site remote from the hospital.

SUMMARY OF THE INVENTION

The present invention provides an integrated patient monitoring system that includes a garment, a monitoring device, and a medication-dispensing unit. The garment is adapted for wearing by a patient, and is adapted to place at least one sensor in communication with the patient's body. The garment includes a connector communicating with the sensor. The monitoring device communicates with the sensor through the connector, and records signals from the sensor. The monitoring device also exchanges signals representing patient status with a central station. Preferably, the patient monitoring system restricts access to the monitoring device to authorized personnel. The medication-dispensing unit communicates with the monitoring device to receive commands from the monitoring device, and to transfer signals representing the status of medication doses to the monitoring device.

The garment of the invention includes at least one sensor, a torso portion adapted to fit the torso of a patient and defining at least one aperture to house the sensor, a sleeve portion adapted to fit the arm of the patient, and a connector communicating with the sensor. Either the torso portion or the arm portion defines a one channel linking the connector to the sensor. This channel houses a signal transmission conduit that couples the sensor to the connector.

The automated medication dispenser includes a carousel, a housing, a dosing drawer, a recovery drawer, and a microcontroller. The carousel defines a plurality of compartments, with each of the compartments adapted to store a dose of medication. The housing includes a surface adapted to receive the carousel, with the housing defining a receptacle and an access aperture communicating between the receptacle and the surface adapted to receive the carousel. A first one of the compartments is positioned to communicate with the receptacle through the access aperture. The medication dispenser provides means for rotating the carousel to position a second one of the compartments to communicate with the receptacle through the access aperture.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

FIG. 1is a block diagram of a remote patient monitoring system10constructed in accordance with the present invention. In a minimum configuration, system10includes central station100and one remote site200. However, the system10can be extended to include any number of remote sites200, limited only by the computational resources provided by central station100.FIG. 1illustrates an exemplary and not limiting embodiment including a plurality of remote sites200a,200b, . . .200n.

Central station100exchanges commands and data with each remote site200over a communication link400. As shown inFIG. 1, communication link400acouples central station100with remote site200a, communication link400bcouples central station100with remote site200b, and communication link400ncouples central station100with remote site200n. It will be understood that for each remote site200provided by system10, a communication link400will couple that remote site200to central station100.

Using communication link400, the central station100transmits commands and configuration data to each remote site200, and receives data sampled and gathered at each remote site200. Typically, central station100is located at a hospital or clinic, where patient support staff or nursing personnel are gathered. Remote site200is a patient location where patient status is to be monitored. A remote site200is typically located either at a patient's home or at a satellite location within a hospital or clinic. Remote site200could also be a patient bed area within a hospital or nursing home. System10allows personnel at central station100to remotely monitor and track multiple patients located at remote sites200. According to several embodiments of the invention, the communication link400is implemented with POTS lines, ISDN lines, WANs, LANs, Intranet links, Internet links, a dial-up telephone line, or other communication lines.

The components and operation of central station100and an exemplary remote site200are described in more detail below.

FIG. 2is a block diagram of a remote site200as shown inFIG. 1. It should be understood that inFIG. 2and the other drawing figures, a single communication line is shown between certain entities for convenience of illustration. It should also be understood further that several parallel communication lines could be used in alternative embodiments.

In a minimum configuration, a remote site200includes a patient monitoring unit214and a garment216housing a plurality of sensors218and adapted to be worn by a patient. In this minimum configuration, patient monitoring unit214receives readings from sensors218, and communicates these readings directly to central station100. Patient monitoring unit214also receives commands from central station100, for example to take readings from a specific one of sensors218.

In the exemplary embodiment shown inFIG. 2, each remote site200includes at least a personal computer (PC)202, a security system226, a serial interface box208, a patient monitoring unit214, a medication dispensing unit212, and a garment216adapted to be worn by a patient. Each of these components is described in detail below, along with their associated subcomponents. Depending on the requirements of a given remote site200, one or more of the components shown in the exemplary embodiment ofFIG. 2can be omitted, such as environmental control system210, medication dispensing unit212, door sensor220, window sensor222, motion and non-motion detection sensors224and240, or security system226and its related sub-components.

PC202is coupled to central station100by communication link400to exchange control signals, data signals, and alert signals with central station100. In an exemplary embodiment, PC202is an IBM-compatible PC equipped with at least a Pentium™ microprocessor, approximately 128 Kb of memory, approximately 500 Mb of hard disk capacity, a serial port, and a communications modem of at least 28.8 baud capacity. It is within the scope of the invention to modify the specific configuration of PC202to support the remote site200. Alternatively, PC202may be a personal-type computer manufactured by other vendors, such as Apple Corporation. As shown inFIG. 2, PC202exchanges both control and data signals with central station100, and sends alert signals to central station100to command the attention of support personnel, when an emergency or other urgent condition occurs.

PC202operates with a suitable operating system, such as Windows NT, developed and sold by Microsoft Corporation of Redmond, Wash., and a database management package such as SQL Server, also developed and sold by Microsoft Corporation. The operating system running aboard the PC202supports multitasking, in an exemplary embodiment.

Serial interface box208is coupled to the serial port of PC202. Because conventional PC architecture can monitor and service only a limited number of serial communication ports (typically up to four with only two interrupts), serial interface box208extends the number of serial devices that PC202can service. A suitable serial interface box208is the model CPM series of control port managers manufactured by Western Telematic, Inc. of Irvine, Calif. In an exemplary embodiment, serial interface box202used RS-232 protocol, but in certain application, other serial protocols may be suitable.

Serial interface box208includes one common port208acoupled to a serial port of the PC202and a plurality of device ports208b, with each one of the device ports208bcoupled to a sensor or monitoring device. In the exemplary and not limiting embodiment shown inFIG. 2, serial interface box208is coupled to serial devices such as environmental sensors204, biosensors206, environmental control system210, patient monitoring unit214, medication dispensing unit212, door sensor220, window sensor222, motion detector224, and non-motion detector240. In this manner, the serial interface box208multiplexes several serial devices onto the serial communication link coupling PC202to serial interface box208.

PC202controls serial interface box208and directs it to connect one of the multiplexed serial devices to the serial port of PC202. In an exemplary embodiment, serial interface box208maintains a look-up table mapping each device ports208bto a given multiplexed serial device. When the serial device coupled to a given device port208bgenerates an interrupt, serial interface box208looks up the interrupting device port208bin the table, and generates an appropriate interrupt to PC202.

As discussed above, serial interface box208may be coupled to one or more of a plurality of multiplexed serial devices, including biosensors206, environmental sensors204, environmental control system210, patient monitoring system214, door sensor220, window sensor222, motion detector224, and non-motion detector240. Biosensors206and environmental sensors204are illustrated and discussed in more detail below inFIG. 7. Environmental control system210is illustrated and discussed in more detail below inFIG. 3.

Door sensor220detects the opening and closing of any doors leading to the patient's room. By tracking when the open/close status of the doors, door sensor220can assist in locating the patient and can detect when other persons have entered the patient's room. Similarly, window sensor222detects the opening and closing of any windows in a patient's room.

Motion detector224provides a signal indicating movement within the patient's room. Suitable motion detectors are commercially available and typically operate using infrared beams or sound waves. PC202monitors the signal from motion detector224to ensure that the patient is active. When there is no signal from motion detector224for some time interval, PC202concludes that the patient is inactive and possibly in danger, and issues appropriate alerts to central station100. Conversely, where it is preferable to detect when there has been no motion in the room over some time interval, a non-motion detector240can be coupled to serial interface box208. Non-motion detector240signals when there has been no motion within the room over some time interval. Using one or both of these detectors, PC202can monitor whether the patient has not moved over a given time interval, and issue appropriate alerts as dictated by the patient's activity level and programmed into patient monitoring system10.

Patient monitoring unit214is coupled to one of the device ports208bprovided by serial interface box208and communicates with the PC202through serial interface box208. Patient monitoring unit214functions to monitor the vital signs of the patient located at remote site200. When the vital signs of the patient fall outside certain thresholds, possibly indicating that the patient is in discomfort, in danger, or in need of attention, patient monitoring unit214generates a nurse-call signal on line214a. The nurse-call signal alerts medical support personnel that the patient demands immediate attention. Also, patient monitoring unit214supplies raw signals representing the patient's vital signs to PC202via serial interface box208. PC202processes these signals to determine the status of the patient independently of patient monitoring unit214. In this manner, PC202provides redundant monitoring of the patient, so that if patient monitoring unit214or PC202fails, the other provides back-up patient monitoring.

A suitable patient monitoring unit214is the Welch-Allyn LifeSign™ unit. The LifeSign™ unit measures the patient's blood pressure and pulse rate, and provides programmable alarms for high and low systolic and diastolic blood pressure and pulse rate. The LifeSign™ unit provides both visual and audio alarms, and stores monitoring data in memory and on hardcopy. The LifeSign™ unit also allows programming of the pressure to which the blood pressure cuff's is inflated, and monitors pulse oximetry as well.

Security system226may be coupled to PC202, to serial interface box208, and to patient monitoring unit214. Security system226is also coupled directly to central station100by a dedicated alert link226a. Using this dedicated alert link226a, security system226can bypass PC202and alert central station100directly. Security system226is coupled to receive the nurse-call signal on line214a, and can alert central station100in response to the nurse-call signal. Security system226is coupled to alert PC202when it receives the nurse-call signal on line214a. This dual-notification structure between PC202and security system226provides separate redundant paths by which to notify central station100when the patient needs attention. If security system226or dedicated alert link226abetween security system226and central station100fails, the link between PC202and central station100provides a back-up communication link. Conversely, if the link between PC202and central station100fails, then dedicated alert link226abetween security system226and central station100provides a back-up communication link.

Security system226functions generally to monitor the status of the patient and the patient's environment, and to generate alert signals when necessary. A suitable security system226is one of the ESPIRIT line of control panels manufactured by Paradox Security Systems, Inc.. The ESPIRIT line of control panels provides integrated keypads for the entry of security codes, and these control panels are configured to monitor a plurality of security zones.

Security system226is coupled to a plurality of subcomponents, including a battery backup system228, a heat sensor230, an emergency pendant238, a display234, and a keypad232. Battery backup system228provides an alternate power supply should the primary AC power supply at the remote site200fail.

Heat sensor230monitors the ambient temperature of the patient's room and generates appropriate alerts when the ambient temperature is either too high or too low. A suitable heat sensor230is the Intellitemp T-1000 manufactured by Intellisense™ Systems, Inc. of Louisville, Ky.

Emergency pendant238is adapted for carrying by the patient, and is coupled to the security system226by a direct wire or a wireless communication link. When the patient requires immediate assistance and cannot speak or otherwise signal his or her distress, the patient presses a button on emergency pendant238to notify security system226(and ultimately central station100) of his or her distress. The Linear Corporation of Vista, Calif. provides a DXR-701 digital receiver, along with a hand-held transmitter unit compatible with the DXR-701. The hand-held transmitter unit can provide a suitable emergency pendant238, if the DXR-701 digital receiver is coupled to the security system226.

Garment216is adapted to house at least one patient sensor218, and patient sensor218is coupled through a connector215to patient monitoring unit214. The physical structure of garment216is illustrated and described below with respect toFIG. 6.

Medication dispensing unit212communicates with serial interface box208to receive commands from PC202, and to transfer signals representing the status of medication doses to PC202. Medication dispensing unit212is described in more detail below with respect toFIGS. 8–15below. It should also be understood that in an alternate embodiment of the invention, medication dispensing unit212can function as a stand-alone unit separate from remote patient monitoring system10.

In an exemplary embodiment, system10provides a video link408between central station100and each remote site200where it is necessary or desirable to have video communication with a remote site200. Video link408allows patients to observe medical personnel demonstrate use of medical devices or diagnostic equipment. In addition, the medical personnel can directly observe the patients to ensure that they properly take medication, that they are in generally good or bad condition, that they are coherent, among other observations.

Visual communication device or means300a, such as a VIA-TV phone, is provided at remote site200with a corresponding visual communication device300bat central station100. In an exemplary embodiment, visual communication devices300are transceivers capable of transmitting and receiving both image and audio-signals. Visual communication device300ais connected to central station100by video link408, over which video and/or image data is exchanged. Video link408may include both dedicated and multiplexed communication lines, which are implemented with the same technologies discussed above with respect to communication links400. It should be understood that if multiple remote sites200are equipped with visual communication devices300a, then the visual communication device300blocated at central station100is coupled to each of the visual communication devices300athat are provided at remote sites200.

FIG. 3is a block diagram illustrating the various components of environmental control system210illustrated inFIG. 2. As shown inFIG. 3, environmental control system210interfaces with serial interface box208over a control line332and a bi-directional data line334. Environmental control system210generally includes several control devices, such as an environmental system controller302, a climate control304, a door control306, a lighting control308, a bed adjustment control310, an oxygen concentration control312, an IV flow rate control314, and a video monitoring unit316. Environmental system controller302is typically a microcontroller programmed to interact with serial interface box208, and to control each of the control devices shown inFIG. 3, according to instructions received through serial interface box208. Climate control304adjusts the heating, cooling and ventilation within the patient's room. As such, climate control304may control the operation of ventilation systems in the room including ceiling fans, ceiling ventilators, or window ventilators in order to enhance the patient's comfort. Climate control304also interfaces with the heating, ventilation, air conditioning (HVAC) thermostat system within the room to regulate the temperature in the room as necessary. In this manner, the climate within the patient's room can be controlled remotely through the environmental control center210by passing commands through serial interface box208.

Door control306regulates access to the patient's room. According to one aspect of the invention, the doors leading into the patient's room are equipped with electromagnetic or other door locks322that are operable by door control306. Door control306responds to commands from environmental system controller306engage door lock322. In this manner, personnel at central station100can regulate access to the patient's room by activating or deactivating door control306, thereby enhancing patient security by controlling door lock322. Door control306may be most suitable for a hospital or nursing home setting.

Lighting control308interfaces with environmental system controller302, and controls at least one light switch324to adjust the level of lighting within the patient's room. In this matter, personnel in central station100can regulate the level of lighting in the room, turning on certain lights and turning off others as necessary to observe the patient or to enhance the patient's comfort. Light switch324can be an on-off switch or a dimmer switch. Lighting control308may be most suitable for a hospital or nursing home setting.

Bed adjustment control310interfaces with environmental system controller302to control the position and configuration of the patient's bed. As understood by those skilled in the art, hospital beds are often provided with electrically operated motors326that configure different portions of the bed, depending on the patient's comfort level and medical necessity. Bed adjustment control310provides an interface to these motors326and enables environmental system controller302to regulate the position of the bed. In this matter, personnel at central station100can adjust the bed remotely to enhance patient comfort and to promote recovery. Bed adjustment control310may be most suitable for a hospital or nursing home setting.

Oxygen concentration control312interfaces with environmental system controller302to control the level of oxygen in the patient's room by regulating oxygen supply328. Oxygen concentration control312includes a sensor that indicates the level of oxygen within the room, and communicates that information to central station100through environmental system controller302and serial interface box208. Certain patients, especially recovering pulmonary and respiratory patients, may require enhanced levels of oxygen in their environment during recovery and rehabilitation. For such patients, it may be necessary to provide supplemental oxygen through a nasal cannula if the oxygen level in the ambient air is insufficient. Oxygen concentration control unit312is coupled to such a nasal cannula and regulates the oxygen level provided in the nasal cannula.

IV flow rate control314interfaces with environmental system controller302, and controls IV fluid supply330to adjust the rate of flow of IV fluids. In this manner, personnel at the central station100can remotely control the flow rate of IV fluids to the patient.

In an additional embodiment of the invention, a video monitoring unit316is provided to interface with environmental system controller302, thereby providing a video link between the patient's room and central station100. This video link is especially useful to facilitate visual contact and interaction between the support staff and the patient.

FIG. 4is a diagram illustrating how central station100and remote site200are coupled to exchange data. The components of central station100shown inFIG. 4are central server402, personnel alert interface404, audio interface406aand visual communication device300b. The components of remote site200shown inFIG. 4are PC202, security system226, audio interface406b, and visual communication device300a.

Visual communication devices300aand300bare linked by a dedicated video link408, which allows the two interfaces to communicate directly. In this manner, nursing personnel at central station100can directly monitor the patient at remote monitoring site200via video link408. A suitable system for implementing visual communication devices300a,300b, and video link408is the VIA TV phone model 1905, manufactured by 8×8, Inc. of Santa Clara, Calif.

Audio link406links audio interfaces408aand408b, allowing audio communication between central station100and remote monitoring site200. Dedicated audio link406provides another redundant level of communication between central station100and remote monitoring site200.

In additional embodiments of the invention, personnel alert interface404is a speaker, a computer monitor capable of displaying suitable messages, a buzzer, or other communication interfaces.

The remote patient monitoring system enhances patient monitoring by providing redundant alert links between remote site200and central station100. At remote site200, security system226and PC202are coupled to personnel alert interface404at central station100by two redundant alert links. Dedicated alert link410links security system226directly to personnel alert interface404, while software alert link414connects PC202to the personnel alert interface404. Furthermore, security system226is linked to PC202by cross-link412.

Security system226and PC202each independently monitor the status of the patient's vital signs at remote site200using separate sets of sensors. When PC202senses data indicating that the patient requires urgent attention, it generates an alert signal along software alert link414to personnel alert interface404at central station100. PC202also generates a signal on cross-link412to security system226, causing security system226to generate an alert signal on dedicated alert link410to personnel alert interface404.

Using two redundant alert links, remote site200provides two alert signals to central station100, one along software alert link414and another along dedicated alert link410. Should one of the links fail, the other link serves as a back-up, thereby insuring that the personnel at central station100are notified of the urgency to attend to the patient at remote site200. Likewise, should security system226detect that the patient needs urgent attention, it can generate an alert signal along its dedicated alert link410, and can also generate appropriate alert signals along cross-link412to PC202. PC202can then generate a redundant alert signal along its software alert link414, thereby providing two alert signals to the personnel at central station100.

In an exemplary embodiment, PC202is equipped with video software202a, alert generation software202b, database202c, and communication port202d. At central station100, central server402is equipped with video software402a, which is linked to video software202aon PC202via software video link418. Suitable video software is the ProShare product from Intel Corporation.

Central server402is also equipped with medical charting software402b, database402c, and a receiver unit402d. Communication port202dis linked to receiver unit402dby a patient data link416. Medical charting software402breceives data from database402c.

Suitable receiver units402dare the SG-SLR single-line digital receiver and the MLR2-DG multi-line digital receiver, both manufactured by Sur-Gard Security Systems LTD of Montreal, Canada.

FIG. 5is a diagram of the several patient sensors218coupled to garment216, as shown inFIG. 2.FIG. 5illustrates several exemplary sensors that can be provided as patient sensors218. In the exemplary and not limiting embodiment shown inFIG. 5, patient sensors218refer collectively to blood pressure sensor500, pulse rate sensor502, respiration rate sensor504, body temperature sensor506, position sensor508, GPS monitor510, and seizure monitor512. It should be understood that at least one sensor is housed in garment216, with the number and type of sensors chosen as appropriate for a given application.

Several examples of optional sensors218are now discussed separately. Sensor500senses the patient's blood pressure, and may be a blood pressure cuff or other suitable device for measuring blood pressure. Sensor502monitors the patient's pulse rate. Sensor504monitors the patient's rate of respiration. Sensor506monitors the patient's body temperature. Sensor508monitors the patient's position and indicates if the patient has fallen. Sensor510is a monitor that interacts with a global positioning system (GPS). GPS monitor510can be used to track the patients whereabouts with precision and to locate and direct a lost or disoriented patient. Seizure monitor512senses whether the patient is having any type of a seizure, for example by monitoring the brain activity of the patient.

FIG. 6is a diagram of an exemplary garment216in accordance with the present invention. Garment216is adapted to house at least one sensor218, and sensor218is coupled to the connector215. Connector215provides a medium through which the sensor218communicates with patient monitoring unit214. Garment216includes a sleeve portion602adapted to fit the patient's upper arm, and a torso portion604adapted to fit the patient's upper body. Sleeve portion602includes a pouch606adapted to receive a blood pressure cuff (not shown) to monitor the patient's blood pressure.

Garment216promotes remote patient monitoring by allowing the patient to properly locate sensor218by putting on garment216and wearing it. Once garment216is sized to fit a given patient, and is fitted appropriately with sensor218, the patient can wear garment216and simultaneously locate sensor218properly. In additional embodiments, garment216can be fitted with a plurality of sensors218to monitor various patient vital signs, depending on the patient's medical condition. Once garment216is equipped with sensor218and fitted to a given patient, medical support personnel no longer need to travel to the remote site200to position sensor218on the patient's body.

Torso portion604and/or sleeve portion602define a channel610linking connector215to each of the sensors218. Garment216promotes remote patient monitoring by allowing the patient to properly locate the sensors on the patient's torso. Channel610houses a signal transmission conduit612that couples each of sensors218to connector215. Depending on the requirements of a given application, signal transmission conduit612may be an electrical conductor or a blood pressure tube coupled to the blood pressure cuff housed in pouch606.

Depending on the patient monitoring designated for a particular patient, sensors218housed in garment216can be bio-sensors, including but not limited to EKG sensors, spirometers, and glucometers. Garment216is configured to place each sensor218in communication with the body of the patient, as required by the characteristics of a particular sensor218.

Depending on the patient monitoring designated for a particular patient, garment218is equipped with a speaker614, a microphone616, and at least one conductor618coupling speaker614and microphone616to connector215. It should be understood thatFIG. 6illustrates speaker614, microphone616, and sensor218in exemplary and not limiting positions. Using speaker614and microphone616, central station100can communicate with the patient to long as the patient is wearing garment218. If a wireless link exists between connector215and patient monitoring unit214, then the patient is free to move away from patient monitoring unit214without losing contact with central station100.

Patient monitoring unit214communicates with sensor218through connector215, and is configured to transmit signals from sensor218to PC202for recording. In an exemplary embodiment, connector215is physically connected to patient monitoring unit214. Alternatively, connector215can communicate with patient monitoring unit214through an RF or other wireless, electromagnetic link. With either embodiment, the patient is free to selectively disconnect connector215from patient monitoring unit214. In the former embodiment, data does not flow between the sensor218and the patient monitoring unit214until the connection is re-made, but with the latter embodiment, data can flow at all times.

Connector215promotes remote patient monitoring by providing a quick-connect, quick-disconnect means allowing the patient freedom of movement while still allowing central station100to monitor the patient's vital signs. Connector215is described in more detail in connection withFIG. 21below.

Typically, patient monitoring unit214is located at the patient's bedside. Patient monitoring unit214is also configured to exchange signals representing patient status with central station100, where nursing or other hospital personnel are located.

FIG. 7is a diagram of several exemplary sensors that comprise biosensors206and environmental sensors204as shown inFIG. 2. Biosensors206and environmental sensors204are coupled to communicate with remote site200through serial interface box208. Biosensors206may include, but are not limited to oxygen saturation sensor700to measure to oxygen level in the patient's bloodstream, electrocardiogram (ECG)702to measure the patient's cardiac activity, stethoscope704, glucometer706, and spirometer708. Each of these bio-sensors206are coupled to serial interface box208to enable them to communicate with the rest of the system, especially patient monitoring unit214and PC202.

Environmental sensors204may include, but are not limited to room temperature sensor710, barometric pressure sensor711, humidity sensor712, carbon monoxide sensor714and smoke sensor716. Room temperature sensor710and humidity sensor712sense the ambient temperature and humidity, respectively, in the patients room. The Perception II® unit manufactured by Davis Instruments provides an indoor temperature, barometric pressure, and humidity sensor that is suitable as room temperature sensor710, barometric pressure sensor711, and humidity sensor712. Davis Instruments also provides Weather Link® software to collect, organize, and export data representing the climate conditions within a patient's room. Carbon monoxide sensor714monitors the level of carbon monoxide accumulating in the patient's room and generates a suitable alarm should the carbon monoxide level become hazardous. Carbon monoxide sensor714also provides a signal through serial interface box208indicating the level of carbon monoxide in the room so that air quantity can be monitored at central station100. Smoke sensor716is a smoke detector configured to generate an appropriate alarm should it detect smoke in the ambient air in the patient's room.

FIG. 8is a block diagram of the various components of medication dispensing unit212shown inFIG. 2. The medication dispensing unit212includes a microcontroller800that interfaces with and controls the various components of an exemplary embodiment of medication dispensing unit212, which components are described separately below.

Display means802include an LCD, LED, CRT, printer, or other suitable means for providing a visual readout to the user. Display means802is coupled to microcontroller800alert the patient to take a dose of medication and also to direct or instruct the patient how to take the dose of medication.

Audio means804includes a speaker and necessary support circuitry and is coupled to microcontroller800to alert the patient to take medication when the dosing interval arrives and also to provide verbal instructions on how to take the medication.

Display means802and audio means804play messages as commanded by microcontroller800. These messages allow medication dispensing unit212to communicate with the patient by playing messages such as greetings, instructions, reminders, and alerts. Typically, a message is associated with an event, such as the beginning or ending of a dosing interval, the patient removing or replacing the dosing drawer, or a patient missing a dose of medication, and so on. The programming of medication dispensing unit212to associate messages with events, and the ability of medication dispensing unit212to support different languages, is described below in connection withFIGS. 25 and 26.

Keypad806is coupled to microcontroller800to allow healthcare workers to login or sign-in at remote site200. Healthcare workers in this context refers to licensed personnel such as nurses or pharmacists if the medication is being dispensed from bulk. However, if the medication doses are pre-packaged and sealed, those doses may be handled and delivered by unlicensed personnel such as delivery couriers. Once they have logged in, the healthcare workers can use the keypad806to interact and communicate with the medication dispensing unit212. Such workers can access data stored on the microcontroller800as necessary or can customize the operation and/or configuration of the microcontroller800for a particular environment.

Dosing drawer832contains a dose of medication to be administered during one dosing interval and keeps it accessible to the patient during the dosing interval. Microcontroller800determines whether dosing drawer832has been removed from medication dispensing unit212by monitoring dosing drawer sensor814. Dosing drawer sensor814may be a micro-switch or other electrical contact that indicates when the patient has withdrawn and removed dosing drawer832. Microcontroller800also controls a dosing drawer lock808that selectively locks dosing drawer832and prevents its withdrawal and removal by the patient until a dosing interval arrives. A suitable dosing drawer lock808employs a solenoid or similar electromechanical mechanism.

Recovery drawer834stores doses of medication that are dropped from dosing drawer832when the patient fails to take the medication within the dosing interval. Microcontroller800monitors the status of recovery drawer sensor816, which is a micro-switch or other electrical contact that indicates when recovery drawer834has been withdrawn and removed. Microcontroller800controls access to recovery drawer834through recovery drawer lock812. Generally, microcontroller800locks recovery drawer834through recovery drawer lock812to prevent any unauthorized access. If an authorized person such as a nurse or other support personnel enters the appropriate security code through keypad806, however, microcontroller800releases recovery drawer lock812and allows recovery drawer834to be removed for inspection.

Carousel838contains a plurality of doses of medication and is rotated as necessary to drop successive doses of medication into dosing drawer832. Rotating means822is coupled to selectively rotate carousel838under the control of microcontroller800. Rotating means822is a suitable electric motor providing feedback such as a stepper motor or a servo motor, along with the necessary interface circuitry coupling the motor to microcontroller800. It should be understood that carousel838is provided as an exemplary embodiment; other devices for storing and dispensing doses of medication are suitable as well.

Lid lock824is attached to the housing of medication dispensing unit212, and is locked in place by microcontroller800to prevent unauthorized access to carousel838. As with recovery drawer834discussed above, lid lock824can be released by microcontroller800if the appropriate security code is entered by authorized personnel through keypad806.

Trap door836is provided to control communication between dosing drawer832and recovery drawer834. According to various aspects of the present invention, trap door836is a separate component from dosing drawer832and recovery drawer834, or is configured as part of a lower portion of dosing drawer832. Trap door control820controls the operation of trap door836under the direction of microcontroller800. As discussed in connection with the flowchart inFIG. 10below, when a dosing interval expires without the patient accessing dosing drawer832, microcontroller800activates trap door control820to open trap door836. When trap door836is opened, the medication contained in dosing drawer832is dropped into recovery drawer834. In an exemplary embodiment, when trap door control820is activated to operate trap door836, microcontroller800is configured to activate an auxiliary alert818to notify the patient that a dosing interval has expired and that the patient has missed a dose.

It will be understood that microcontroller800synchronizes the operation of trapdoor836and the rotation of carousel838, so that the next dose of medication is dropped into dosing drawer832after trap door836closes to cut communication with recovery drawer834. In this manner, microcontroller800prevents the next dose of medication from being dropped directly into recovery drawer834.

Although the exemplary embodiment discussed herein discloses trapdoor836communicating between dosing drawer832and recovery drawer834, other alternative embodiments for preventing successive doses of medication from accumulating in dosing drawer832are within the scope of the invention. For example, various embodiments of trapdoor836are provided, with trapdoor836having sliding members or pivoting members.

In yet another embodiment, dosing drawer832and recovery drawer834can communicate in a side-to-side relationship, in addition to communicating in the upper-and-lower relationship discussed in the above exemplary embodiment. If dosing drawer832and recovery drawer834communicate in a side-to-side relationship, then a sweeping means may be provided to swipe the dose of medication from dosing drawer832into recovery drawer834when the patient misses a dose. A suitable sweeping means may be a blade or wiper adapted to fit the internal configuration of dosing drawer832. This sweeping means can include a mechanical linkage under electronic or pneumatic control, but can also include a pneumatic system using compressed air or suction to transfer the dose of medication. In the upper-lower embodiment discussed above, a pneumatic system can also be used to assist the movement of the medication between dosing drawer832and recovery drawer834.

In still further embodiments of the invention, dosing drawer832can be inverted to dump its contents into recovery drawer834if the patient missed a dose, thereby preventing double-dosing. Also, dosing drawer832can be configured to tip or otherwise release its contents into recovery drawer834through the sides, top, bottom, front, or back of dosing drawer832.

In an additional embodiment, particularly where narcotics or other especially valuable drugs are dispensed in a home environment, recovery drawer834can be made more secure by recessing it laterally into housing900until the patient misses a dose. When the patient misses a dose, recovery drawer834can be pivoted about a vertical axis or slid laterally into position beneath dosing drawer832. If this embodiment is chosen, housing900is provided with a recessed opening sized snugly to fit recovery drawer834. This configuration promotes security by presenting only a side wall of recovery drawer834when recover drawer834is recessed into housing900and dosing drawer832is removed, rather than presenting trapdoor836. Typically, a side wall of recover drawer834is more rugged and harder to defeat than trapdoor836, because unlike trapdoor836, the side wall has no moving parts. In this embodiment, the moving parts of trapdoor836are recessed into, and protected by, housing900.

A communication port826is coupled to microcontroller800. An exemplary communication port826is a serial port that allows data to be uploaded or downloaded from microcontroller800as necessary. Communication port826might be used, for example, to upload new software into microcontroller800, to download data from microcontroller800reflecting taken or missed doses over a given time interval, or to upload a new medication dispensing schedule into microcontroller800. Communication port826also allows support personnel to otherwise interact with microcontroller800, such as with a portable laptop PC, and to connect medication dispensing unit212with PC202.

Communication port826can be configured to support Internet transmission of data to and from medication dispensing unit212. For example, if the patient misses a dose, medication dispensing unit212can be configured to broadcast an e-mail message to the pharmacist, medical support personnel, or to a physician. Also, medication dispensing unit212could be programmed via Internet communication, if appropriate security precautions are taken.

Clock828is coupled to microcontroller800to provide a real-time clock signal and to coordinate and synchronize the various functions of microcontroller800. Using signals from clock828, microcontroller800keeps track of a dose schedule that specifies when dosing intervals begin and end. In this manner, microcontroller800tracks the beginning and ends of the dosing intervals using the real-time kept by clock828.

Dosing schedule840defines how many dosing intervals occur over a given time, and when each of these dosing intervals begin and end. The structure of an exemplary dosing schedule840is discussed below in connection withFIG. 9.

Data log830is a record maintained by microcontroller800containing entries for successful doses and missed doses. This record is updated by microcontroller800. Data log830can be accessed by authorized personnel through key pad806by entering an appropriate password or other security code. The structure of data log830is discussed below in connection withFIG. 10.

According to an exemplary embodiment, smart card interface810can be provided as a means for loading dose instructions to microcontroller800. The term “smart card” in the context of this application refers to a credit-card sized device that is equipped with a microprocessor and memory and that is capable of transferring information to or from a central computer. A smart card can be built into carousel838, and programmed by the pharmacist at the time that the carousel838is stocked with medication. At that time, the smart card810can be configured or programmed with the appropriate dose instructions in whatever language is appropriate for a given patient.

When the carousel838is loaded into the medication dispensing unit212, the smart card interface810also loads the dose instructions from the carousel838. In this manner, microcontroller800is updated with the appropriate instructions when a new carousel838is loaded. In additional embodiments, a magnetic strip reader can be used as an alternative to the smart card interface810. In addition, dosing instructions may be loaded at remote site200through serial port826. In an additional embodiment, dose instructions can be transmitted by central station100directly to microcontroller800.

FIG. 9illustrates an exemplary data structure for dosing schedule840, as illustrated inFIG. 8. Dosing schedule840is arranged as a linked list or an array of a plurality of records. In an exemplary embodiment, at least one of these records is associated with each of the days of the week. For example, if 4 doses are to be administered during a given day, there would be four records appearing in dosing schedule840for that given day.

Referring to an exemplary row844,FIG. 9shows that each row contains at least 3 data fields, which are numbered841,842, and843. First data field,841, contains a sequence number for a given dose. This sequence number can be ordered within a given day or can be ordered within a given week as suitable for a given environment. Second data field,842, specifies the beginning time and the ending time of a given dosing interval. Third data field,843, contains a status flag, which indicates whether a dose should be administered during that dosing interval. The flag can be assigned one value to indicate that a dose should be administered, and a second value to indicate that the dose should be skipped. In this manner, the same number of dosing intervals can be defined uniformly for each day of the week, and the doses to be administered during a given day can be adjusted as necessary by modifying the status flag in third data field843. Also, if the status flag in data field843is set to an inactive status for a given dosing interval, this signals microcontroller800that dosing drawer832will not be accessed during that dosing interval, and that microcontroller800should not log a missed dose for that dosing interval.

FIG. 10illustrates an exemplary structure of the data log830illustrated inFIG. 8. Data log830is arranged as a linked list or an array of a plurality of rows, such as an exemplary row849. A header structure845contains pointer to each of the rows in data log830. By referencing header845, microcontroller800can readily search and locate any row in the data log830, such as exemplary row849.

Exemplary row849includes three sub-data fields: first data field846, second data field847, and third data field848. First data field846stores a time and date stamp indicating the time at which the entry corresponding to that row is made in data log830. Second data field847contains a status indicator that stores the status of the medication dose corresponding to a given row in data log830. The status indicator can take on at least three values: a first value indicating that the dose was taken successfully, a second value indicating that the dose was missed, and a third value indicating that the medication dispensing unit212malfunctioned. Third data field848stores a unique identifier within a series of doses. For example, third data field848might indicate that a given dosing period was the first dose of a given day, a second dose in a given day, etc. By referring to data log830, microcontroller800can determine when and if particular doses were missed by traversing data log830and selecting each record containing a second data field847having a status indicating a missed dose. Microcontroller800can also determine if there is a certain dose within a day that a patient chronically misses by searching for each missed dose and cataloging those missed doses.

FIGS. 11–14provide exemplary, and not limiting, views of the exterior of the medication dispensing unit212.FIG. 11is an elevated perspective view of the medication dispensing unit212, shown from the front.FIG. 11shows the medication dispensing unit212as assembled, and features carousel838positioned on medication dispensing unit212on the top of housing900. Dosing drawer832is shown positioned in the front of housing900.

Housing900includes a surface900aadapted to receive carousel838. Surface900ais typically the top surface of housing900. Housing900defines a receptacle904into which dosing drawer832is slidably positioned.

FIG. 12is a perspective view of the bottom of medication dispensing unit212, showing the opening905, which receives recovery drawer834.FIG. 9Bshows medication dispensing unit212without recovery drawer834installed.

FIG. 13is an elevated perspective view of medication dispensing unit212, with carousel838detached.FIG. 13also features opening905on the right side of housing900. An access aperture902communicates between receptacle904and surface900aadapted to receive carousel838. Dosing drawer832is positionable within receptacle904and is in communication with access aperture902.

FIG. 14is an exploded diagram of carousel838, which is shown inverted better to illustrate its essential features. Carousel838includes upper portion838band lower portion838a. Upper portion838bdefines a plurality of compartments910. Lower portion838asnaps into upper portion838bto trap the contents of compartments910within compartments910. If carousel838is removed from housing900, then the contents of compartments910can be accessed by removing lower portion838a.

Lower portion838ais an annular ring having approximately the same outside diameter as upper portion838b. The radial thickness R of lower portion838ais approximately the same as the radial length R of compartment910. This feature allows lower portion838bto maintain the medication in compartments910.

Lower portion838ais keyed to surface900aof housing900, such as by the exemplary keying means913aand914a, which engage complementary keying means913band914bshown inFIG. 13. Thus, lower portion838ais maintained stationary relative to housing900. Conversely, upper portion,838bis free to rotate relative to housing900and lower portion838a. Upper portion838bincludes keying means916that engage rotating means822(shown in block form inFIG. 8). Thus, rotating means822rotates upper portion838brelative to housing900and lower portion838a.

Lower portion838adefines an aperture915that communicates with one compartment910when upper portion838band lower portion838aare assembled. When carousel838is assembled and inverted, gravity pulls the contents, if any, of the one compartment910through aperture915and into access aperture902. As rotating means822rotates upper portion838b, successive compartments910are positioned above aperture915to drop their contents through aperture915.

Access through aperture915is controlled by hinged member915a. In one embodiment, hinged member915acan be configured to open under control of microcontroller800when carousel838is loaded onto housing900, and to remain open until carousel838is exhausted, typically after one month. However, in an additional embodiment, hinged member915acan be configured to open and close as each compartment910is rotated into communication with aperture915. For example, hinged member915acan open when a first dosing interval arrives, thereby allowing the dose of medication to drop from compartment910into dosing drawer832. If the patient fails to access that dose, however, hinged member915acan be configured to close, thereby blocking subsequent doses from other compartments910from dropping into dosing drawer832. After the missed dose is rectified, such as by alerting medical support personnel or a pharmacist, the hinged member915acan re-open and resume operation so long as the patient does not miss any doses.

Once the medication exits carousel838through aperture915, it drops into access aperture902defined by housing900. A first one of the carousel compartments910is positioned to communicate with the receptacle904through the access aperture902defined by housing900. Preferably, carousel838is positioned atop housing900, with a first carousel compartment910above access aperture902. In this manner, gravity causes the dose contained in the compartment to drop through access aperture902into dosing drawer832. Preferably, access aperture902is a substantially vertical channel, thereby offering the advantage of allowing the medication to drop directly downwards without contacting the sides of access aperture902. Thus, the medication does not contaminate, and is not contaminated by, the sides of access aperture902.

In this manner, dosing drawer832receives the dose of medication from first carousel compartment910through access aperture902. Preferably, dosing drawer832has an open top to allow the medication to drop in from access aperture902. As described above, medication dispensing unit212is oriented so that gravity pulls the medication from first carousel compartment910, through access aperture902, and into dosing drawer832.

Each compartment910is adapted to store a single dose of medication. Carousel838is pre-loaded with doses of medication to be administered over a given period, such as a week or a month. Carousel838is filled in bulk by a pharmacy, if the pharmacy is equipped to process carousels838. Thus, the pharmacist segregates the medication into individual doses when filling the prescription, rather than having hospital workers administer individual doses to patients from medication supplied in bulk. This approach saves hospital labor costs and reduces the risk of error when administering individual doses.

According to different aspects of the present invention, carousel838is configured to electronically store dose instructions and schedules as encoded by the pharmacist. Further, carousel838transmits these electronic instructions to medication dispensing unit212when the carousel838is loaded onto housing900.

FIG. 15is a flow chart illustrating the flow of processing performed by microcontroller800of medication dispensing unit212. Processing starts at BEGIN block1000.

At block1002microcontroller800evaluates whether a dosing period has begun. Microcontroller800is programmed with a dosing schedule, which defines at least one dosing interval. During this dosing interval, the patient is expected to retrieve the dose for that interval from medication dispensing unit212. Until a dosing interval begins, microcontroller800loops back through block1002, as indicated by the N branch.

Once the dosing interval has begun, as indicated by the Y branch from block1002, microcontroller800proceeds to block1004. At block1004, microcontroller800engages rotating means822to rotate carousel838into position to drop a dose of medication into dosing drawer832.

At block1006, microcontroller800unlocks dosing drawer832, if that drawer is locked for any reason. Thus, the patient is free to withdraw dosing drawer832to access the medication.

At block1008, microcontroller800causes an audio alert to be sent to the patient, such as by beeps, whistles, or other audio alerts. These audio alerts should be chosen to attract the patient's attention and to remind him or her to take the medication.

At block1010, microcontroller800causes visual alerts to be sent to the patient such as by blinking lights, blinking LEDS or other visual alerts, once again to attract the patient's attention.

At block1012, microcontroller800provides dose directions to the patient. Such dose directions may include instructions on whether to take the medication on a full or empty stomach, with or without liquid, etc. These directions may also specify how many pills should be in dosing drawer832, so that the patient can verify that the dose dropped into dosing drawer832is correct. These dose directions may be communicated to the patient over audio means804and/or visual means802.

At block1014, microcontroller800evaluates whether the patient has removed dosing drawer832from housing900of medication dispensing unit212. When microcontroller800senses that the patient has removed dosing drawer832, as indicated by the Y branch from block1014, microcontroller800proceeds to block1030. So long as the patient has not removed dosing drawer832, and so long as the dosing interval has not expired, microcontroller800loops between blocks1014and blocks1016. Microcontroller800detects when the patient has removed dosing drawer832by monitoring dosing drawer sensor814.

At block1030, microcontroller800evaluates whether the patient has replaced dosing drawer832into housing900of medication dispensing unit212. When microcontroller800senses that the patient has replaced dosing drawer832, microcontroller800proceeds by the Y branch to block1032. So long as the patient has not replaced dosing drawer832, microcontroller800loops via the N branch through blocks1034and1036and back to block1030.

At block1032, the patient has accessed the dose and has replaced dosing drawer832. Microcontroller800then writes a log entry for the dose taken by the patient. Once the log entry has been written, microcontroller800returns to step1000and proceeds to step1002, where it loops until next dosing interval begins.

At block1034, microcontroller800inserts a delay period to give the patient some time to replace dosing drawer832without being instructed to do so. A suitable delay period might be five or ten minutes.

At block1036, microcontroller800provides an audio or visual message to the patient reminding him or her to replace dosing drawer832. Such a message may take a form such as, “please remember to replace the dosing tray.”

At block1016, microcontroller800evaluates whether the dosing interval started in block1002above has expired. So long as that dosing interval has not expired, as indicated by the N branch from block1016, microcontroller800returns to block1014. Accordingly, so long as the patient has not removed dosing drawer832and the dosing interval has not expired, microcontroller800loops between blocks1014and1016until the dosing interval expires. When the dosing interval expires, microcontroller800proceeds along the Y branch from block1016to block1018.

If the dosing interval expires without the patient removing dosing drawer832, then the patient has missed the dose. At block1018, the patient has missed the dose and microcontroller800provides a suitable message over visual means802or audio means804. Such a message might indicate that the patient has missed the dose and that the dose is no longer accessible. The message might also indicate to the patient when the next dose period will begin.

At block1020, microcontroller800writes a log entry for the missed dose. Such a log entry might include the time and date at which the dose period expired, perhaps along with the sequence number within a series of doses. For example, the log entry could indicate that on a given day, the patient has missed the third dose of a series of five doses.

At block1022, microcontroller800can alert central station100that the patient has missed a dose. This alert to central station100enables personnel at that station to take appropriate action because the patient has missed a recent dose. Also in block1022, microcontroller800can provide auxiliary alerts to the patient such as lights, buzzers or etc. that notify the patient that he or she has missed a dose. Microcontroller800can also instruct the patient to contact central station100if missed doses are critical to the patient's medication regime.

At block1024, microcontroller800locks dosing drawer832to prevent any further access to dosing drawer832, since the dosing interval has expired. This locking process prevents the patient from taking successive doses of medication too close together.

At block1026, microcontroller800activates trap door836at the bottom of dosing drawer832, thereby dropping the dose of medication contained in dosing drawer832into recovery drawer832. Once dropped into recovery drawer834, the dose of medication is no longer accessible to the patient. In this manner, microcontroller800prevents the patient from inadvertently double-dosing on two successive doses of medication. Otherwise, when the next dosing interval arrives, the next dose of medication would be dropped into dosing drawer832along with the previous dose. If the patient took two doses at once, severe consequences could result.

Once the dose of medication has been removed from dosing drawer832, microcontroller800proceeds to block1028. At block1028, dosing drawer832is unlocked because it is now empty and therefore poses no medication hazard to the patient.

Once dosing drawer832has been unlocked, microcontroller800returns to block1000and awaits the beginning of the next dosing interval, as indicated in block1002.

FIG. 16is a flow chart illustrating the processing performed by the software running aboard PC202as illustrated inFIGS. 2 and 4. As described above, each remote site200includes a local PC202. Periodically, PC202enters a sampling interval, wherein it polls each monitoring device or sensor at remote site200to sample data from those devices and sensors. PC202enters data from each of the devices and sensors into a local database maintained aboard PC202.

Processing begins at block1100and proceeds to block1102to connect to one of the devices or sensors located at remote site200. Exemplary monitoring devices and sensors are biosensors206, environmental sensors204, patient monitoring unit214, door sensor220, window sensor222, motion detector224, and non-motion detector240.

At block1104, data is collected or sampled from the device or sensor that was accessed in block1102above. At block1106, the collected data is stored in a local SQL database maintained by PC202at the remote site200. At block1108, a time stamp is generated and assigned to the data stored in the SQL database in block1106above. At block1110, PC202disconnects from the given device or sensor connected to in block1102above, thereby terminating the current session with that monitoring device or sensor until the next sampling interval arrives.

At block1112, PC202examines the data that was sampled and collected from the monitoring device or sensor, and determines whether any of that data represents a patient condition that should generate an alarm. If so, PC202proceeds to block1114to generate a suitable alarm signal to central station100. If not, PC202proceeds to block1116to sample a next monitoring device or sensor, if any, that is yet to be sampled in the current sampling interval.

At block1114, PC202generates an appropriate alarm to the central station100. After generating this alarm, PC202proceeds to block1116.

At block1116, PC202evaluates whether there are more monitoring devices or sensors to be sampled during the current sampling interval. If so, PC202returns to block1102to connect to another monitoring device or sensor. If there are no more monitoring devices or sensors to be sampled during this sampling interval, PC202proceeds to block1118, where it delays to await the next sampling interval. When the next sampling interval begins, PC202returns to block1102to connect to and sample the first monitoring device or sensor for that sampling interval.

FIG. 17is a diagram of an exemplary database record storing the data collected during the execution of the software illustrated by the flowchart inFIG. 16. Particularly,FIG. 17illustrates the database record for storing the data collected at block1106.

The database record contains a timestamp data field to indicate the time of the sampling interval. According to different aspects of the invention, the time stamp is associated with all of the entries in the database record, or individual time-stamps are associated with each of the entries in the database record.

The rest of the entries in the database are determined by the particular monitoring equipment chosen to equip a given remote monitoring site200, andFIG. 17illustrates an exemplary configuration. In this exemplary configuration, an entry is provided for door sensor220, window sensor222, motion detector224, non-motion detector240, the data from biosensors206, the data from environmental sensors204, and the data from patient monitoring unit214. The entry for the data from biosensors206can be subdivided into sub-data fields, with each sub-data field corresponding to one of biosensors as illustrated inFIG. 7. For example, the database record provides a data field for the oxygen saturation level as provided by oxygen saturation sensor700, a data field for a digitized ECG waveform as provided by ECG sensor702, and data fields for readings from stethoscope704, glucometer706, and spirometer708.

In an exemplary embodiment, the data stored from environmental sensors204is divided into sub-data fields in the same manner as the biosensor data. For example, the database record provides a sub-data field for storing the room temperature from room temperature sensor710, a sub-data field for the room humidity from humidity sensor712, and a sub-data field for the barometric pressure from barometer711. The database record also provides additional sub-data fields for the carbon monoxide level from carbon monoxide sensor714, and for the air quality signal from smoke detector716. Likewise, the data provided by patient monitoring unit214can be subdivided and assigned to sub-data fields. For example, the pulse rate, the respiration rate, and the blood pressure data can be stored in separate sub-data fields for convenience.

It will be understood that the database record shown inFIG. 17is exemplary only, with actual database records varying depending on the specific equipment provided at a given remote site200.

As the software illustrated inFIG. 16iterates through several sampling intervals, PC202generates and populates one copy of the database record illustrated inFIG. 17. After several sampling intervals, PC202generates a time-stamped patient record, with each record corresponding to the exemplary database record illustrated inFIG. 17. This database record can then be imported into a suitable, commercially available database application, and the data can then be analyzed to isolate trends in patient data or to identify patient hazards.

The database record ofFIG. 17also illustrates the parameters that PC202uses in block1112ofFIG. 16to determine whether it should generate an alarm. For example, by reviewing the door status and window status, PC202can determine whether anyone has had unauthorized access to the patient's room. By checking the motion detector status and the non-motion detector status, PC202can determine whether the patient is exhibiting an expected level of physical activity. By examining the database record responding to the biosensor data, PC202can determine whether the patient's vital signs are within tolerances. If one or more of the patient's vital signs are out of tolerance, then PC202can generate an appropriate alarm to central station100. The same considerations apply, for example, to the data from patient monitoring unit214. Likewise, PC202can evaluate the data provided by environmental sensor204to ensure that the climatic conditions within the patient's room are within tolerance.

FIG. 18is a flowchart of the software running on server402. As stated above, server402is located at central station100. Periodically, server402enters a sampling interval, wherein server402connects to each of the remote sites200to download the entries in the local database maintained by PC202at each remote site200. When server402accesses a given remote site200, server402accesses the entries made in the local database maintained by PC202at the given remote site200. Server402then downloads those local database entries into a central database maintained by server402.

Processing starts at begin block1200and proceeds to block1202, where server402connects with and logs into a given remote site200to access the local database maintained there. At block1204, server402accesses the local database at the remote site200. At block1206, server402copies the entries from the local database at the remote site200, and transfers those entries into a central database maintained by server402.

At block1208, server402generates and assigns a unique patient identifier to correspond to the remote site200that server402is currently accessing. This patient identifier serves to indicate which remote site200is associated with a given group of database entries in the central database maintained by server402. At block1210, server402associates the given patient identifier with the group of database entries retrieved during block1206above.

In block1212, server402exports the data from the central database to the medical charting software, shown inFIG. 4. At block1214, server402checks to see if any remote sites200remain to be accessed in the given sampling interval. If so, then server402returns to block1202to log into the next remote site200. If not, then server402proceeds to block1216and awaits the next sampling interval, at which time server402once again logs into each of the remote sites200and downloads new database entries.

FIG. 19is a diagram of an exemplary database record maintained on server402, shown inFIG. 2. Server402generates and populates the exemplary database record shown inFIG. 19as it logs into remote sites200during a given sampling interval.

Reference numerals1218and1220designate individual records corresponding to two patient identifiers, which are described above inFIG. 18. The patient identifier corresponds to a given remote site200. For example, a first patient may reside at a first remote site200aand be assigned a first unique patient identifier number. A second patient may reside at a second remote site200band be assigned a second unique patient identifier number.

Within an exemplary patient identifier record, such that indicated by reference numeral1218, the database record provides a plurality of sub-data fields, as indicated by reference numerals1222,1224, and1226. Each of these three sub-data fields can contain at least two data fields, one data field for a time stamp, and a second data field for patient data. The timestamp indicates the time at which the patient data field is populated. The contents of the patient data field depends upon the configuration of the given remote site200corresponding to the patient identifier.

The database record illustrated inFIG. 19provides an exemplary patient data field. However, it should be noted that different remote sites200are configured differently depending on the requirements of a given patient. Accordingly, the contents of the database field corresponding to that remote site200varies. It should also be noted that although three timestamp records are shown inFIG. 19, as server402executes successive sampling intervals, additional time-stamped records will be appended beneath the exemplary patient identifier data fields1218and1220. In addition, althoughFIG. 19shows two patient identifier records for simplicity, the exemplary database record can be extended to accommodate any number of remote sites200with a corresponding number of unique patient identifiers.

FIG. 20is a flowchart of the software executing on serial interface box208. Serial interface box208serves to connect PC202to the several multiplexed serial monitoring devices and sensors shown inFIG. 2. The software shown inFIG. 20serves to regulate the flow of data between PC202and the several multiplexed serial devices and sensors.

Processing begins at block1300and proceeds to block1302to await an interrupt request (INTR) signal. Upon receiving an INTR signal, processing proceeds to block1304, where serial interface box208evaluates whether the INTR signal represents a request to read data from one of the multiplexed serial devices. If so, serial interface box208proceeds to block1306to service the INTR signal as a request to read. If not, serial interface box208proceeds to block1312, where it evaluates whether the INTR signal represents a request to write data from one of the multiplexed serial devices. If so, serial interface box208proceeds to block1314to service the INTR signal as a request to write. If not, the INTR signal was either erroneous or intended for some purpose other than executing reads or writes from/to the multiplexed serial devices, and serial interface box208loops back to block1302to await the next INTR signal.

Blocks1306–1310represent the general steps of an interrupt service routine (ISR) that services requests from PC202to read data from one of the multiplexed serial devices or sensors coupled to serial interface box208. For example, PC202may generate an interrupt to read the data from biosensors206, environmental sensors204, patient monitoring unit214, medication dispensing unit212, or the other multiplexed devices coupled to serial interface unit208.

In block1306, serial interface box208identifies the serial device from which PC202is reading, and maps that device to a corresponding port of serial interface box208. At block1308, serial interface box208reads the data from the serial port. Depending on the size of the data, this data can be either buffered or latched to await forwarding to PC202. Buffering refers to storage in memory for later access; latching refers to temporary storage, such as in a flip-flop. In block1310, the data read from the serial port is written to PC202, either from a buffer or from transceiver latches.

Blocks1314–1318represent the general steps of an interrupt service routine (ISR) that services requests from PC202to write data to one of the serial devices or sensors coupled to serial interface box208. For example, PC202may generate an interrupt to write command or configuration data to environmental control system210, patient monitoring unit214, medication dispensing unit212, or other devices coupled to serial interface unit208.

In block1314, serial interface box208identifies the serial device to which PC202is writing, and maps that serial device to a corresponding serial port of serial interface box208. At block1316, serial interface box208reads data from PC202. Depending on the size of the data, this data can be either buffered or latched to await forwarding to the serial device. At block1318, the data is written from serial interface box208to the serial device identified in block1306.

FIG. 21is an exemplary side view of connector215as connected to patient monitoring unit214. In an exemplary and not limiting embodiment, connector215provides a male coupling, and patient monitoring unit214provides a cradle2104, which is a complementary female coupling. Cable2102runs between connector215and sensor218housed in garment216(FIGS. 5 and 6). The contents of cable2102depend upon the types of sensors218housed in garment216. In an exemplary embodiment, cable2102can contain conductors corresponding to an ECG sensor and a blood pressure cuff. In additional embodiments, cable2102can contain conductors corresponding to speaker614and microphone616shown inFIG. 6. Loop2106can be joined to connector215so as to extend from cradle2104. Loop2106allows the patient to disconnect connector215by pulling on loop2106, rather than cable2102, thus preventing the patient from fatiguing the connections between cable2102and connector215by pulling on cable2102.

FIG. 22is an exemplary front view of cradle2104shown inFIG. 22, with connector215removed. Cradle2104is shaped to receive connector215, and the U-shape shown inFIG. 22is exemplary rather than limiting. One or more alignment pins2204can be provided at the bottom of cradle2104to ensure that connector215is coupled properly to cradle2104. Alignment pin2204can be keyed to engage complementary structure provided in connector215, such as one or more suitable apertures. In an exemplary embodiment shown inFIG. 22, cradle2104provides at least one electrode2206to connect to connector215. For example, electrode2206can be an electrical lead connecting to an ECG monitor of patient monitoring unit214. If garment216is equipped with a blood pressure cuff, then cradle2104provides pressure connector2202to couple the blood pressure cuff in garment216with patient monitoring unit214.

FIGS. 23 and 24are top views of cradle2104according to alternate embodiments of the invention. InFIG. 23, cradle2104has a ovoid shape, and provides an exemplary configuration of alignment pins2204, electrodes2206, and pressure connector2202as described inFIG. 22above. InFIG. 24, cradle2104has a rectangular shape, and provides another exemplary configuration of alignment pins2204, electrodes2206, and pressure connector2202as described inFIG. 22above. It should be understood thatFIGS. 21–24illustrate connector215that uses a hard-wired, physical connection to patient monitoring unit214. If an RF link is used rather than a hard-wired connection, then the RF link will substitute for the structure shown inFIGS. 21–24.

The exemplary embodiments shown inFIGS. 21–24feature a push-pull connection for ease of connection/disconnection by the patient. However, if patient dexterity is not a concern, then fluidic/pneumatic connectors are available from LEMO-USA of Santa Rosa, Calif., which connectors may be suitable for pressure connector2202shown above. Also, TronoMed®, Inc. of San Juan Capistrano, Calif. markets a TronoMate® connector that may be suitable for electrodes2206above.

FIG. 25is a diagram of an exemplary data structure2500used with medication dispensing unit212shown inFIG. 2. Data structure2500enables medication dispensing unit212to communicate effectively with a patients speaking a plurality of different languages.

In an exemplary and nonrestrictive embodiment, data structure2500can be arranged as a matrix having a plurality of columns and a plurality of rows. Header row2504is shown merely to describe the contents of columns beneath each entry in header row2504, and may or may not be included in data structure2500. Column2508stores message identifiers, while columns2510a–2510nstore messages corresponding to those identifiers in a plurality of languages.

In the exemplary embodiment shown, column2508contains a sequence of unique identifiers, with one identifier corresponding to each message supported by medication dispensing unit212. Medication dispensing unit212plays these messages over audio means804and display means802(seeFIG. 8) under the control of microcontroller800. By playing selected messages, medication dispensing unit212can at least greet the patient, instruct the patient on how to take medication, remind the patient to take a dose, alert the patient when he or she misses a dose, and notify the patient when to take the next dose.

In the exemplary embodiment shown, columns2510a–2510nstores text messages in a plurality of different languages. The number n of columns2510a–2510nvaries according to the number of languages supported by medication dispensing unit212. For example, column2510amight contain English versions of the messages corresponding to the message identifiers listed in column2508. Similarly, column2510bmight contain German versions of the same messages, while the remaining columns2510c–2510nmight contain versions in still more languages.

In the above manner, row2512acontains versions of the message corresponding to message identifier1in n different languages, with one message in each language contained in one each of the columns contained in row2512a. Similarly, row2512bcontains versions of the message corresponding to message identifier2in n different languages, with one message in each language contained in one each of the columns contained in row2512b, and so on through each row in data structure2500.

FIG. 26is a diagram of an exemplary data structure2600that can be used in conjunction with data structure2500shown inFIG. 25to enable medication dispensing unit212to provide messages in several different languages. In the exemplary embodiment shown inFIG. 26, data structure2600is a matrix mapping a plurality of events in column2602to a plurality of message identifiers2604.

Column2602contains an entry for each event associated with a message. Exemplary events might include a greeting to the patient, instructions on taking medication, a reminder to return dosing drawer832, an alert that the patient has missed a dose, and so on. For purposes of illustration only, the numbers1–M in column2602represent these exemplary events conceptually and symbolically. For example, event #1might command medication dispensing unit212to issue a greeting to the patient, event #2might command medication dispensing unit212to provide prescription dosing instructions, and so on. Also, the exemplary entries shown in column2604are strictly for illustration purposes, and the entries in column2604can vary in implementation.

Column2604contains a message identifier corresponding to each entry in column2602. The message identifiers in column2604serve as indices into data structure2500shown inFIG. 25, and correspond to the entries in column2508of data structure2500. For example, if event #1in data structure2600represents a command to issue a greeting to the patient, then data structure2600maps event #1to message identifier #5. Message identifier #5selects a row in data structure2500shown inFIG. 25. Given the row selected in data structure2500, microcontroller800can select the correct language for the patient by traversing columns2510athrough2510n.

Medication dispensing unit212is programmed using data structures2500and2600in the following manner. Using the data structure2600, medical personnel configure each message supported by medication dispensing unit212by associating each event in column2602of data structure2600with a corresponding message identifier in column2604. As stated above, the message identifiers in column2604index into data structure2500. For example, nurses or orderlies might configure such messages as the greetings, warnings, or reminders, while pharmacists or physicians might configure such messages as the medication dose instructions or other directions for the patient.

An important feature of medication dispensing unit212is its ability to allow programming in a first language, while providing patient instructions in a second language. For example, medical personnel might program medication dispensing unit212by reviewing a dictionary of messages in a first language, such as English. As the personnel peruse and locate appropriate messages, they assign those messages to specific events by manipulating data structure2600. When medication dispensing unit212is fully programmed with messages for each event, then it is sent on-site to remote site200.

When medication dispensing unit212arrives on-site, either the medical personnel or the patient can select the language that medication dispensing unit212uses to provide messages on display means802and audio means804. The language used on-site may be the same or a different language as that used to program medication dispensing unit212. The linkage between column2604in data structure2600and column2508in data structure2500provides this flexibility. This linkage is not language-specific; instead, it relies on logical or conceptual linkage between the events listed in column2602of data structure2600and the multi-lingual messages shown in column2510athrough column2510nof data structure2500.

In a further embodiment, medication dispensing unit212can support customized messages, in addition to providing a built-in dictionary of messages. In this manner, authorized medical personnel can associate a custom message with selected events, as discussed above. As a security precaution, however, microcontroller800can be configured to require entry of a password or other security code before allowing entry of customized messages. By restricting dissemination of the password or security code, medical personnel can reduce the risk that messages will be improperly changed.

FIG. 27is an exploded view of medication dispensing unit2700. Medication dispensing unit2700is an alternative embodiment of medication dispensing unit212previously described. Medication dispensing unit27includes several features not previously described. One of these features is a medication cassette2702(also referred to as a medication holding device, carousel or a medication carousel) which is also shown inFIG. 28.

Medication cassette2702has an inner ring2708comprised of a plurality of medication dosing compartments910and an outer ring2706comprised of a plurality of medication dosing compartments910. Each of the medication dosing compartments910are for containing medication doses for delivery to a patient at an appropriate predetermined dosing period or interval. In an exemplary embodiment each of the inner and outer rings2708and2706, respectively, is used to contain a separate week's dosing of medication. Together, inner ring2708and outer ring2706provide medication for delivery to a patient at the appropriate time each day, up to four times per day, for a two week period. In this exemplary embodiment, there are thus a total of 56 medication dosing compartments910for containing medication doses. Each ring holds 28 medication dosing compartments910to provide up to four doses per day of medication. It would be understood that reference to a dosage of medication throughout this specification refers to a dose of a single medication or respective doses of multiple medications (whether related or unrelated) that may be required to be taken at the same time of day. A medication dose is thus any amount of medicine, whether a single medicine or multiple medicines, that is to be delivered to a patient to be taken at a particular time period. In addition, if a patient does not require four doses of medication per day, additional days or weeks of medication doses can be loaded into medication cassette2702, thereby extending the time that medication dispensing unit2700can dispense medicine from a two week, four dose per day system up to an eight week one dose per day system, for example. It would be understood by those skilled in the art that using fewer or greater numbers of dosing compartments910, or additional numbers of rings, will effect the amount of doses that can be delivered per day, as well as the duration (number of days) for which scheduled dosing can be maintained without the need to refill medication cassette2702.

In an exemplary embodiment, an iButton™2712is located in the center of medication cassette2702. An iButton™ is a computer chip housed in a stainless steel can that is manufactured by Dallas Semiconductor Corporation. The iButton™ is used to store information regarding a particular patient's medication needs. This can involve one or more of the following: the particular medicines to be delivered by medication dispensing unit2700, the particular dosing periods for the medicines, the language that is spoken by the patient, the delivery address and emergency contact information for the patient, the patient's doctor, the patient's pharmacist, the patient's medical plan, the patient's allergies and other medical information. In addition, the iButton™ can store information about the delivery of medicine to the patient between filling medication cassette2702. It can store when the patient took the medication, whether any doses were missed or whether there were any malfunctions in medication dispensing unit2700. Other information can be stored in iButton™2712as required by the user/provider of medication dispensing unit2700. An iButton™ may also contain its own processor, in addition to a memory. The iButton™ is one example of a memory storage device that can be used in the present invention. Other memory storage devices, such as smart cards, magnetic cards, memory cards, PCMCIA cards and EEPROMS can be used, as will be understood by those skilled in the art.

Th iButton™ can also be used to store identification information. In this way, a nurse, pharmacist, healthcare worker or maintenance worker can carry his or her own personal iButton™ having a unique identifier. Access to various functions in the system can then be limited to those individuals who are permitted to have access. In addition to the iButton™, other methods of unique identification such as a smart card, iris scan, finger scan, voice recognition, personal code, or magnetic card could be used. The choice of different security methods is depended upon a desired level of security and durability of the security device.

Medication cassette2702operates similar to upper portion838bof carousel838shown inFIG. 14, except with two rings of medication dosing compartments910instead of the single ring shown for upper portion838shown inFIG. 14. In addition, as shown inFIG. 29, instead of having a cover (or upper portion838a, as shown inFIG. 14), for keeping the medication doses contained in medication dosing compartments910with a single fixed aperture for transferring medication from a compartment to recovery drawer834, medication cassette cover (or lower portion)2704contains two medication apertures, a different one for each of the inner and outer rings2708and2706, respectively. In an exemplary embodiment, medication cassette cover2704contains a movable delivery disc2728containing a first aperture2730for opening to outer ring2706and a second aperture2732, for opening to inner ring2708. Movable delivery disc2728operates by a gear (not shown) engaging rack2734. Movable delivery disc2728does not have to rotate 360 degrees, as it should be necessary for rotation between the positions where first aperture2730and second aperture2732engage their respective rings. Only one aperture should open onto a dosing compartment910of a respective ring at one time. This way, only the medication dose from a single dosing compartment910will be delivered at one time.

Additional embodiments for cover2704include a movable delivery disc2728having a single aperture that can engage a dosing compartment910from either inner ring2708or outer ring2706. Because the shape of dosing compartments910are different for inner ring2708and outer ring2706, the exemplary embodiment shown inFIG. 29uses first aperture2730and second aperture2732, with each having a shape to match that of the respective dosing compartment with which it engages. This reduces the risk of a medication getting stuck and not being delivered. Another embodiment for cover2704includes a rocker type of delivery system which pivots from open (deliver medication) to closed. This rocker type f delivery system can have a door that flaps open/closed or cup that transfers the medicine, similar to the function of a night deposit system at a bank or an old style pay telephone change return. A solenoid operated delivery system could be used to cause a spring loaded rocker to open or close.

A lower portion, or base,2736is attached to cover2704via a hinge2738, forming a clamshell type enclosure or cartridge unit2740. When medication cassette2702is loaded into base2736, cover2704can be closed over medication cassette2702and secured shut to base2736. Various means of securing cover2702to base2736can be used, including a bayonet type closure, a spring type closure having engaging lips, or a magnetic closure. Once securely engaged after the medication doses are filled or approved by a pharmacist, a locking system is used to ensure that the medication doses are not tampered with. This can be accomplished with a key lock or plastic “ratchet” type loop closures that allow movement in only one direction (to seal tighter, without reversing). When filled and securely locked, the entire medication cartridge2704with medication cassette2702can be delivered to a patient's medication dispensing unit for use by the patient. In such an embodiment, iButton™2712is accessible through cover2704via an opening2748. In this way, the delivery to the proper patient can be confirmed without opening the security seals of cartridge unit2740.

To load medication into the various medication compartments910of inner ring2708and outer ring2706, of medication cassette2702, a pharmacy unit2714is used by the pharmacist of medication loading/delivery service that is responsible for providing medication to the patient. Pharmacy unit2714allows loading of medication cassette2702remote from (external to) medication dispensing unit2700. Pharmacy unit2714, as shown inFIG. 30, is also a clamshell type unit, in an exemplary embodiment. Pharmacy unit2714has a loading cover2742and a base2744, attached to each other via a hinge2750and mating type latches (not shown). In an additional exemplary embodiment, loading cover2742is detachably attached to base2744via snaps or latches that engage with a mating lip at select locations on the outside of base2744. Pharmacy unit2714is designed so that medication cassette2702can fit inside of base2744with loading cover2742closed on top.

Loading cover2742has a plurality of inner ring loading slots2720and outer ring loading slots2718. Each loading slot is cut into a loading wheel2746which can rotate back and forth enough to open or close over the dosing compartments910. This is the equivalent of moving the distance of approximately one dosing compartment, or 12.8 degrees in the exemplary embodiment shown (360°/28 compartments per ring).

Loading wheel2746is operated using an indexing wheel2716. Pharmacy unit2714also contains a gear (not shown) that can engage with rack2710of medication cassette2702. The location of the gear is shown as the raised area2717of cover2716. Rotating indexing wheel2716causes the gear, engaged with rack2710, to turn. This causes medication cassette2702to advance (or reverse) in accordance with the rotation of indexing wheel2716.

When medication cassette2702is placed into pharmacy unit2726, it is oriented in such a way so that it can be indexed for proper filling of the medication dosing compartments910. In an exemplary embodiment, a first dosing compartment910of outer ring2706is indexed as number1with a number “1” marked on the side of medication cassette2702. This index number is visible through an opening (not shown) in pharmacy unit2714. If each of the medication dosing compartments910of outer ring2708is so labeled, the pharmacist will always know which medication dosing compartments910are being filled. An audible or tactile system can be used, as well to alert the pharmacist that the next dosing compartment is aligned.

Other means for indexing medication cassette2702inside of pharmacy unit can also be used, including but not limited to mechanical, optical, electrical or electromechanical indexing systems. Other examples include a solenoid controlled advancement, a motor driven unit or an electronically controlled motor driven unit. Each of these systems would provide precise movement of the loading slots to the appropriate compartments910. In addition, loading wheel2746could also be operated using an electrical or electromechanical means.

In an exemplary embodiment, an inner ring loading slot2720and outer ring loading slot2718are paired, with a separate pair corresponding to each day of the week. This provides a total of seven pairs or 14 total loading slots. Essentially, both weeks (rings) are being filled at the same time. Underneath loading wheel2746there are a corresponding number of loading tubes (not shown, to the 14 loading slots in the exemplary embodiment. In this way, when the loading slots are rotated into the open position, a corresponding loading tube is underneath the loading slot to guide the medication into the appropriate dosing compartment910of inner ring2708and outer ring2706. In this exemplary embodiment, which can hold four doses per day for two weeks, a pharmacist can fill the entire medication cassette in four passes (one pass per daily dose times four daily doses).

When providing medication to be loaded in to medication cassette2702, a pharmacist loads the desired medication doses (which may be one or more medications) in to each loading slot. This can be done by pouring the medicine into the center of loading wheel with the loading slots in the closed position. The medicine is then dosed into each of the loading slots with a spatula, finger, etc. This is then repeated for any other medicine that is being dosed at the same a pharmacist then advances the loading slot to the appropriate medication dosing compartment910by moving indexing wheel2716so that the loading slot is over the appropriate medication dosing compartment910.

An iButton™ reader (not shown) is a device which can retrieve data from an iButton™ located in the inside of pharmacy unit loading cover2742in order to identify the patient's medication cassette for synchronization with the appropriate medication dispensing unit2700. In addition, pharmacy unit2714may contain a second iButton™ reader to identify the pharmacist who is loading the medication, by the pharmacist's personal iButton™, and permit that pharmacist to access the private patient information contained in the iButton™ attached to medication cassette2702. The pharmacist can have a display screen connected to the pharmacy unit that displays the exact medication, doses and dosing times to ensure proper loading of medication cassette2702and download of the patient's medication receiving history from the last filling of medication cassette2702. Connection to a computer or monitor can be via serial port, infrared ling, parallel port or other communication means/protocol. Again, the security system is not limited to the iButton™ disclosed herein.

Referring back toFIG. 27, medication dispensing unit2700also has a housing2762upon which a PC board (not shown) is mounted, a dosing drawer832,a recovery drawer834, a display802, as well as a cover2705. An iButton™ reader(not shown) is also located in medication dispensing unit2700to read information from iButton™2712located on medication cassette2702. Cover2705can be lockable to provide additional security to the unit. Recovery drawer834and dosing drawer832can be oriented to open in different directions or in the same direction.

Display802is mounted on a display housing which also contains a keypad2768for entering information into medication dispensing unit2700and/or iButton™2712located on medication cassette2702. Display802can display a range of information, including instructions, errors/malfunctions/problems and status. A “GET DOSE” button2764and an “EMERGENCY” button2766are also included.

Dosing drawer832is comprised of a main unit2752having a dosing compartment2754. Main unit2752has a base plate2760with a recovery drawer aperture2758disposed therein. A sliding door2756is sandwiched between base plate2760and main unit2752. If a dosing period is missed, sliding door2756is slid back, allowing the missed medication dose to fall through recovery drawer aperture2758into recovery drawer834. In an exemplary embodiment, dosing drawer832is motorized. A magnet (not shown) placed on the back of dosing drawer832can be used to engage with a metallic plate (not shown) inside of medication dispensing-unit2700to insure a secure fit when loaded inside of medication dispensing unit2700.

As an additional security device, the exemplary embodiment of medication dispensing unit2700contains an iButton™ reader2707. iButton™ reader2707can be used as a security device in medication dispensing unit2700to identify a person permitted to access the unit.

For example, medication dispensing unit2700can work in two ways. The first way is the non-safety version whereby the patient is permitted to remove a delivered dose of medication from medication dosing drawer832by themselves. In a safety version of medication dispensing unit2700, however, another person (or a confirmation of the patient's identity) is required to remove the medication dose from medication dosing drawer832and administer it to the patient. The safety version may be required in many situations such as in a nursing home with a patient that is physically not able to remove and administer the dose or a situation where safety requires that an individual will deliver and confirm that the medication dose was taken. In the safety version, the person who removes and administers the dose to the patient would have their own iButton™ having a unique serial number that is passed over iButton™ reader2707in medication dispensing unit2700. In this way, a secure confirmation of the person removing and administering the medication is made before that person is allowed access to the medication in medication dosing drawer832. An additional security feature could involve not only the use of the iButton™ but the entry of a personal code on keypad2768attached to medication dispensing unit2700.

In an exemplary embodiment, the use of the iButton™ provides a durable not easily erased or destroyed electronic memory device having a unique identifier. The iButton™ of the person administering the dose in the safety version, as well as iButton™2712on medication cassette2702, can be programmed from a remote facility, a main delivery facility such as a nursing home or a pharmacy, depending upon the particular application. This would be determined by the particular supplier of the medication-dispensing unit. Communication with medication dispensing unit can be via a variety of communication means including a serial connection, a parallel connection, a modem connection (either direct dial or through the Internet), an RF connection or an infrared connection. Various combinations of communication connections can also be used. For instance, a medication dispensing unit2700installed in a patient's home may have a direct telephone connection (or an Internet connection) as the “permanent connection. A nurse or other worker may be able to make a temporary connection at the patient's home with a portable computer or printer via a serial port or infrared connection. In this way, medication dispensing unit can be accessed on site to obtain or download information.

In an exemplary embodiment, medication dispensing unit2700has a serial connection, as well as a built in modem.

Various methods may be used to insure proper medication delivery to the patient. One method involves dropping medication from a missed dosing period into recovery drawer834. In an exemplary embodiment, one missed dose can be taken from the recovery drawer by the patient, after the missed dosing period has expired. If a second medication dosing period is missed, recovery drawer834may stay locked until a code is entered on keypad2768or other secure access determination is made. The medication from the missed periods can then be disposed of or returned to the pharmacy. In other embodiments or for particular circumstances, depending upon the medications and the patient, all missed doses may remain locked in recovery drawer834without access by the patient. In another embodiment, recovery drawer834can be eliminated by only allowing a medication dose to leave a medication dosing compartment910upon confirmation by the patient or healthcare worker that they are ready for the medication dose by entering a code on keypad2768, using the GET DOSE button2764or using their personal iButton™. If a dosing period is missed, the medication would remain in its medication dosing compartment910.

When it is time for medication to be dispensed, the patient or person administering the medication can be notified audibly through a speaker such as speaker2709, through a visual prompt at display802, a remote system such as a remote lamp or strobe light, remote buzzer/bell, an X-10 system, an NC/NO system, a pager or telephone call. If connected to a telephone line, a pager or remote telephone or Internet connection can be dialed as well.

In addition to notifying the patient or the person administering the medication, medication dispensing unit2700can notify a monitoring facility of various events such as when the medications were taken, by whom, when the last medication cassette2702was changed, as well as emergency or priority conditions such a malfunction, low battery, missed doses, or out of medication. This information can be transmitted to a number of means, such a display802speaker2709, telephone connection to telephone, pager, or Internet connected computer, or a through a serial connection to a computer, or radio frequency transmission if a RF unit is mounted within medication dispensing unit2700.

Although illustrated and described herein with reference to certain specific embodiments, the present invention is nevertheless not intended to be limited to the details shown. Rather, various modifications may be made in the details within the scope and range of equivalents of the claims and without departing from the spirit of the invention. For example, the above description referred several times to electrical circuits, especially for controlling the various components of medication dispensing unit212. However, pneumatic control circuits could be substituted for these electrical control circuits without departing from the scope of the invention.