# Patent

## Title
Method and apparatus for recognition of inhaler actuation

## Abstract

A medication confirmation method and apparatus for confirming administration of medication employing an inhalable medication administration apparatus. The method of an embodiment of the invention includes the steps of capturing one or more video sequences of a user administering medication employing the inhalable medication administration apparatus, storing the captured one or more video sequences, capturing one or more audio sequences of the user administering medication employing the inhalable medication administration apparatus and storing the captured one or more audio sequences. At least one of the stored video sequences and at least one of the stored audio sequences are then analyzed to confirm that the user has properly administered the medication.

## Background
CROSS REFERENCE TO RELATED APPLICATIONS
This application is Continuation in Part Application of U.S. patent application Ser. No. 13/235,387, filed Sep. 15, 2011 to Hanina et al., titled APPARATUS AND METHOD FOR RECOGNITION OF PATIENT ACTIVITIES, currently pending, which is in turn a non-provisional application that claims the benefit of U.S. Provisional Patent Application Ser. No. 61/498,576, filed Jun. 19, 2011 to Hanina et al., titled APPARATUS AND METHOD FOR RECOGNITION OF PATIENT ACTIVITIES, the entire contents thereof being incorporated herein by reference. This application is also a Continuation in Part Application of U.S. patent application Ser. No. 12/815,037, filed Jun. 14, 2010 to Hanina et al., titled APPARATUS AND METHOD FOR RECOGNITION OF PATIENT ACTIVITIES WHEN OBTAINING PROTOCOL ADHERENCE DATA, currently pending, which claims the benefit of U.S. Provisional Patent Application Ser. No. 61/331,872 filed May 6, 2010, to Hanina et al., titled APPARATUS AND METHOD FOR RECOGNITION OF PATIENT ACTIVITIES WHEN OBTAINING PROTOCOL ADHERENCE DATA, the entire contents of each of these applications also being incorporated herein by reference.


FIELD OF THE INVENTION
This invention relates generally to patient compliance in medication administration protocol scenarios, and more particularly to an apparatus and method for the collection, analysis and transmission of data related to patient movements related to such medication administration in order to improve adherence with prescribed drug protocols in accordance therewith. The invention further relates to a tracking and guidance training system for individuals taking prescribed medication, preferably employing computer vision and activity tracking, and may also provide incentives such as reminding a patient of the benefits of a particular medication, providing the patient monetary points or other remuneration on the screen, and one or more reminders to take an appropriate medication. The invention finally preferably relates to the use of computer vision and activity recognition for determination of proper administration of injectable, inhaler-based, or other non-pill medication administration in which proper position and action sequence is important, confirming proper identity of the medication device, and proper actual ingestion, inhalation or injection of the medication, but is equally applicable to pill based medication administration sequences.
BACKGROUND OF THE INVENTION
Dr Lars Osterberg, M.D. and Dr, Terence Blaschke have reported in the New England Journal of Medicine, Adherence to Medication, (N Engl J Med 2005; 353:487-97) 2005 an alarming lack of adherence to required medication protocol, further noting that while the average rates of adherence in clinical trials is categorized as “high”, this number still comprises only rates of 43 to 78 percent. Most importantly, the authors note “The ability of physicians to recognize nonadherence is poor, and interventions to improve adherence have had mixed results.” Adherence, p. 487. The authors conclude “Poor adherence to medication regimens is common, contributing to substantial worsening of disease, death and increased healthcare costs.” Adherence, p. 494. The Trend Repot Series, 2008 Patient Adherence Update: New Approaches for Success, October 2008, report similar discouraging statistics. This broad range may possibly contribute to the public confidence in the FDA approval process and the importance of continued surveillance of a drug throughout the process. Furthermore, it may help to explain why, according to the Journal of the American Medical Association (JAMA May 1, 2002), one out of every five new drugs that comes to market in the US is found to have serious or life-threatening adverse effects—unknown or undisclosed at the time of approval. It is against this backdrop of poor adherence, and potential danger to patients, that the present invention operates.
It has been widely recognized that methods and systems for insuring proper medication ingestion or administration by individuals are very important in defending against unnecessary sickness, deaths and other problems. Giving instructions and then letting patients fend for themselves has been shown not to work particularly well. This is because it is not only the improper ingestion of medicines that is the primary cause of medical danger. Rather, an overall lack of sufficient patient guidance is also part of the problem. Further, the inability to confirm a proper prescription regimen being provided to a user in the first place may cause a number of other problems with the use of such medication. As has been shown in regards to various public health medication administration situation, such as administration of tuberculosis medication by the WHO, Directly Observed Treatment (DOT) improves compliance of patients. Global Tuberculosis Control: A Short Update to the 2009 Report, World Health Organization, 2009. As is shown in this report, funding for implementing DOT programs is high. Thus, the ability to implement such a program with less of a financial burden would be desirable.
Traditionally, participants attend introductions and follow ups for clinical trials in-person. Other patients outside of the clinical trial setting attempting to adhere to a particular medication protocol similarly are given a prescription and a particular set of instructions from a prescribing medical provider or prescribing doctor, and then compliance is measured at a next visit with that prescribing professional through traditional methods of counting unused medication, and patient interviews. Thus, data collection is similarly limited to patient visits, rather than on a daily basis. These old methods such as patient questioning and medication counting have been proven to be inadequate measures of adherence and offer no information on dose timing and drug holidays (omission of medication for three or more sequential days).
Compliance technologies can increase the statistical power of clinical trials. Through the use of such technology, clinical events can be precisely linked to medication use history. Captured data can be linked to other sources such as EDC, patient diaries and data collected by the physician. Technologies can create many possibilities for remote visits and data capture. While smart packaging technologies exist such as RFID-enabled computer chip technology, smart blister packs and MEMS caps (microprocessor in a bottle cap), they are: a) invasive and need to be physically attached to the medications; b) are non-conclusive regarding compliance—a patient may activate the technology without ingestion of the medication; c) remain largely unadopted in clinical trials by the pharmaceutical and biotech companies due to their high cost; and d) take a longer time to implement. Further, electronic patient diaries allow for ease of entry of data by a patient. These diaries, however, are still subject to issues related to compliance with medication adherence. Thus, even if a patient is meticulous about entering information into the diary, and thus complying with the requirements for data entry, there is still no guarantee that they are properly taking medication at prescribed times. Additionally, none of these techniques allow for the monitoring of non-pill related medications, such as the user of inhalers or injectable medication. These medication delivery systems require additional monitoring, as know when administration took place is not sufficient. Rather, positioning and other technique issues may substantially affect the proper delivery and efficacy of particular medications.
Particularly related to inhalable medication, determining proper inhalation of medication has been difficult. A number of different systems have been proposed and employed to make such a determination. There are several electronic monitors that have been reported in the literature for use with Metered Dose Inhalers (MDIs) or dry powder inhalers (DPIs). The “nebulizer chronolog” device and the “Doser Clinical Trials” device have been used with MDIs. The nebulizer chronolog is a microprocessor device built into the sleeve housing an MDI; it records the date and time of each inhaler actuation, by activation of a microswitch. The Doser Clinical Trials device is described as an pressure-activated device, also used with MDIs. It is a round, flat device secured to the top of the canister, and it records only the number of daily uses a period of 45 days. A similar MDI electromechanicalcounter has also been employed The ElectronicDiskhaler allows monitoring of the Diskhaler DPI, by drug blister piercing and airflow through the device. A similar device, the Turbohaler Inhalation Computer has been used with the Turbohaler DPI, known as Turbuhaler in the United States. An electronic monitor has also been reported for the Diskus DPI.
It should be noted that not all electronic monitors actual inhalation of medication by patients. With the chronolog, medication can be sprayed into the air, or the switch flicked manually. The Electronic records both blister perforation and airflow, which some indication that inhalation occurred following loading. Researchers have investigated adherence with aerosol therapy, using the nebulizer chronolog, in comparison with canister weighing and patient self-report with a group of patients with chronic obstructive pulmonary disease (COPD). This study found that both canister weights and self-report overestimated adherence with prescribed therapy among patients who were not informed of the nebulizer chronolog's recording ability
Even these electronic systems, as recognized by J M Foster et al. (J Asthma. 2012 August; 49(6):657-62. Epub 2012 Jun. 2), are not without criticism, however. As indicated, they actually measure compliance with actuation of the metered-dose inhaler and not direct information about medication ingestion.
Jo Carol et al. stated that “The most reliable method for research purposes, although not practical in a clinical setting, may be a combination approach that includes pill counts, patient self-report, and electronic monitoring.” (Carol J. et al, Patterns to Antiretroviral Medication, The Value of Electronic Monitoring, AIDS, 17 (12), pp 1, 763-767, October 2003. To date, technologies alone have only been used to monitor compliance rather than to encourage it. Furthermore, there has been no comprehensive system provided that allows for the management of multiple patients and multiple patient populations. While current technology may allow poor compliers to be recognized, as will be described below, the proposed apparatus and method of the present invention will help to encourage pharmaceutical compliance with non-pill delivered medications, and tackle some of the problems that are encountered in the clinical trial process in particular, and the medication protocol monitoring problem in general.
A number of systems exist that provide instructions to a user regarding when to take a medication and records when the user indicates that a medication has been taken. U.S. Pat. No. 7,359,214 describes such a system. A device is provided that provides instruction to a patient regarding medications to take. Furthermore, the system may provide a method for determining that the prescription is appropriate given the patient's conditions, and other medications he or she may already be taking. The system may monitor the dispensing of medicine in accordance with a predetermined treatment protocol. While such a system provides many improvements for easing a burden on the patient, this system suffers in many ways and in particular in ways relevant to the administration of clinical trials and other active patient monitoring of medication adherence.
Most importantly, this system provides no mechanism for actually confirming that a patient is in fact properly administering required medication as required in a clinical drug trial, as prescribed by a prescribing physician in the case where adherence to a particular regimen may prove to be critical to efficacy of the prescription regimen, in various public health scenarios, in situations where failure to keep up a prescription regimen can potentially harm a population as a whole, such as the generation of antibiotic-resistant bacteria strains, in various disease management scenarios, or in home care situations where maintaining proper control of administering healthcare professionals is critical. Further, while the system may be sufficient for one who is in full possession of their mental faculties, any individual who may have difficulty following directions, or one who is actively avoiding medication may still not be taking required medication after it is dispensed. Thus, participants may be forgetful, visually impaired, or otherwise do not believe in the benefit of taking such medication, and may thus not properly log medication administration. Furthermore, as it applies only to pill based oral medication, the system requires preloading of various medications into a dispenser, and thus likely requires regular visits by an administering manager to be sure appropriate medications are in fact properly loaded therein. It is surely possible that an inexperienced user may place incorrect medications into the device, or may somehow provide incorrect dosages into the device. Additionally, for potentially more complex regimens, there is no method provided for insuring that a user is able to follow such a protocol, and to thereafter confirm that the user has in fact taken all required medications in accordance with any provided instructions or the like, or has taken the medications according to one or more specifications or followed suggested procedures. Furthermore, this system is expensive and requires constant maintenance to confirm that the various mechanical parts are in working order. Finally, as noted above, the system has no application to non-pill based medications.
U.S. patent application Ser. No. 11/839,723, filed Aug. 16, 2007, titled Mobile Wireless Medication Management System provides a medication management system employing mobile devices and an imaging technology so that a user is able to show a pill to be taken to the system, and the system can then identify the medication. Patient histories are available to an administrator, including various vital signs as measured by the system. Images may also be taken of the patient, provider, medication container or the like. While the system professes to ensure adherence to a protocol, the system only provides such help if requested by a user. There is in fact no particular manner in which to ensure actual adherence or ingestion of the medication, or the relationship of adherence to the efficacy or safety of the drug over time. When requiring adherence to a predetermined protocol for a clinical trial, this is particularly relevant. Similarly, there is no mention of non-pill based medications.
While adherence to medication in general is poor, requirements for use of inhalable medications, such as metered dose inhalers (MDI) and dry inhalers, have an increased burden in that simply confirming actuation of such an inhaler is insufficient. It is important to use inhalers correctly to get the full dosage and benefit from the medicine. By using the MDI correctly, medication has a better chance to reach the small airways, increasing medication effectiveness. Using a good technique can also help reduce the side effects of medications. However, use of proper technique with such inhalers is difficult to instruct and monitor in that between 28% and 68% of patients do not use metered-dose inhalers or powder inhalers well enough to benefit from the prescribed medication, and 39%-67% of nurses, doctors, and respiratory therapists are unable to adequately describe or perform critical steps for using inhalers. Even if patients are able to demonstrate correct technique during consultation with a health professional, they may not maintain this standard at other times. Improvement in patient compliance with therapy will require better doctor-patient communication, improved patient education, the tailoring of therapy to the individual and possible novel strategies such as offering feedback to the patients on further their level of compliance.
Additionally, existing systems fail to maintain an audit trail for post administration review by a medical official or other clinical trial administrator, and further cannot therefore confirm confirmation of proper medication administration or population management.
Therefore, it would be desirable to provide an apparatus that overcomes the drawbacks of the prior art.
SUMMARY OF THE INVENTION
In U.S. patent application Ser. No. 12/620,686, filed Nov. 18, 2009, titled Method and Apparatus for Verification of Medication Administration Adherence; currently pending, U.S. patent application Ser. No. 12/646,383, filed Dec. 23, 2009, titled Method and Apparatus for Verification of Clinical Trial Adherence, currently pending; U.S. patent application Ser. No. 12/646,603, filed Dec. 23, 2009, titled Method and Apparatus for Management of Clinical Trials, currently pending; and U.S. patent application Ser. No. 12/728,721, filed Mar. 22, 2010, titled Apparatus and Method for Collection of Protocol Adherence Data, currently pending, the contents of these four applications being incorporated herein by reference, the inventors of the present invention have proposed a system, method and apparatus that allow for complete control and verification of adherence to a prescribed medication protocol or machine or apparatus use in a clinical trial setting, whether in a health care provider's care, or when self administered in a homecare situation by a patient.
These applications present the only medication management system that may determine whether a user is actually following a protocol, provide additional assistance to a user, starting with instructions, video instructions, and the like, and moving up to contact from a medication administrator if it is determined that the user would need such assistance in any medical adherence situation, including clinical trial settings, home care settings, healthcare administration locations, such as nursing homes, clinics, hospitals and the like, and in clinical trial settings.
The inventive solution, in accordance with one or more embodiments of the present invention, may provide a webcam software solution for distribution by medical professionals to provide a training system for training patients to properly administer their inhalable, injectable, or other non-pill based medication, to automate direct observation of medication administration of inhalable, injectable or other medications, and to provide an audit trail of medication adherence and patient behavior. The inventive system may visually and audibly track medication adherence to inhalable, injectable and other medication during training and actual medication administration in clinical trials or other medication administration scenarios on webcam-enabled laptops, tablets, smartphones and other platforms without real time human supervision. The inventive system may visually and audibly recognize a fixed series of actions, each comprising part of the medication administration process.
In accordance with an embodiment of the present invention, a motion capture procedure for capturing motion information related to the administration of injectable, inhaler-based, or other non-pill based medication, may be utilized in accordance with one or more of the inventions noted in the above-referenced applications. Such administration information preferably includes confirming a correct device, medication inserted therein, and then confirming actual ingestion, inhalation or injection of the medication by the patient. Therefore, in accordance with an embodiment of the present invention, a method and apparatus may be provided for analyzing captured patient motion data, transmitting such captured patient motion data to a remote location (or processing such captured information locally, in whole or in part), receiving information from a remote location (or from a processor maintained locally) and providing information to the patient as preferred in accordance with the present invention.
Further in accordance with an embodiment of the present invention, one or more predetermined motion sequences may be determined and correlated to one or more corresponding medication administration instructions for administration of injectable, inhaler-based, or other non-pill based medication. These predetermined motion sequences may be provided as a number of generic motion sequences, as one or more customized motion sequences, or a combination of both, and preferably may include tracking of a medication administration device, thus confirming in real time ingestion, inhalation or injection of medication by the user. The group of predetermined motion sequences may comprise a motion language that may be applied to one or more different medication administration sequences, including injectable medication administration, inhaler-based medication administration, other non-pill based medication administration and the like, and other healthcare related processes, such as hand washing or the like, medication administration personnel acting as prescribed or the like, thus allowing for an easy to program generic medication administration sequence, but also allow for customization where appropriate and necessary. These programmed motion sequences may then be applied in accordance with the inventions noted in the applications above.
In yet another embodiment of the invention, one or more methods may be provided for confirming that a user is properly performing one or more of these predetermined motion sequences. Thus, as a user positions themselves or an object before an image capture device, a display may indicate to the user whether the position, distance, and/or skew and angle are correct. If not, the user is preferably provided with indications as to how to correct any one or more of these issues. The motion sequences may include capture of use of an inhaler, injectable device or the like. Accumulation of such motion sequences may be employed to count total dosages, remind the user when to refill their medication prescription, warn when the user might be running low on medication, and order refills in advance based upon the number of times the user has used the device.
In a still further embodiment, one or more audio cues may also be employed. Thus, for example, in the case of an inhaler-based medication, audio monitoring of sound from both the inhaler and patient may be performed and used to further confirm that the patient has in fact properly administered the medication. Therefore, not only may positioning of the inhaler in the correct location and relative angle be confirmed, but activation of one or more inhaler mechanisms, and the inhaling of the medication by the patient upon such activation may also be confirmed. Micro movements may also be determined, so that small movements associated with medication administration in general, and ingestion, inhalation or injection in particular can be used to confirm actuation of a device, for example. Thus, in an embodiment of the invention, fingers actuating a device, other small movements, audio signals, and the like may be combined to provide greater confidence in device actuation, and inhalation, ingestion or injection confirmation. Similar monitoring may also be performed with injectable and other non-pill based medications.
The system in accordance with one or more of the various embodiments of the present invention may also be applicable to training situations where the user is provided with various feedback instructions related to training to properly administer medication in a clinical trial or other disease management scenario. In accordance with various embodiments of the present invention, for example, when applied to an inhaler, a patient may be requested to shake the inhaler before use. When applied to an injectable medication, the patient may be requested to confirm refrigeration or confirm proper sanitization of an injectable tip with an alcohol swab or the like, confirm that the needle is not bent, or that an injectable solution or medication has not changed color, or otherwise become spoiled in a manner that is visually detectable. While online training and instructions may be available currently, the interactive nature providing feedback to the user regarding their use and following of protocol is critical in improving adherence and patient action.
Still other objects and advantages of the invention will in part be obvious and will in part be apparent from the specification and drawings.
The invention accordingly comprises the several steps and the relation of one or more of such steps with respect to each of the others, and the apparatus embodying features of construction, combinations of elements and arrangement of parts that are adapted to affect such steps, all as exemplified in the following detailed disclosure, and the scope of the invention will be indicated in the claims.



BRIEF DESCRIPTION OF THE DRAWINGS
For a more complete understanding of the invention, reference is made to the following description and accompanying drawings, in which:
FIG. 1 is a flow chart diagram depicting a method in accordance with an embodiment of the invention;
FIG. 2 is a flowchart diagram depicting a video sequence generation method in accordance with an embodiment of the invention;
FIG. 3 is a flowchart diagram depicting a video sequence capture method in accordance with an embodiment of the invention;
FIG. 4 is a depiction of a positioning process in accordance with an embodiment;
FIG. 5 is a depiction of another positioning process in accordance with an embodiment of the invention;
FIG. 6 is a depiction of yet another positioning process in accordance with an embodiment of the invention;
FIG. 7 is a depiction of a motion tracking process in accordance with an embodiment of the invention;
FIG. 8 is a flowchart diagram depicting a combined video and audio detection system for detecting proper medication administration of an inhaler in accordance with an embodiment of the invention;
FIG. 9 is a flowchart diagram depicting an audio signature recognition system in accordance with an embodiment of the invention;



DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
The invention will now be described making reference to the following drawings in which like reference numbers denote like structure or steps. Referring to FIG. 1, a data flow overview in accordance with the operation of an embodiment of the present invention is shown. In accordance with this embodiment of the invention, information about a particular drug to be the subject of a clinical trial, to be employed in a public health or disease management situation, or the like, or other medication administration program or prescription may be provided in a database 105, and existing industry medication information databases 110 are preferably employed to access prescription, interaction, application, and other available information about any number of proposed prescription and non-prescription medications and their possible interaction with the clinical trial or other medications. Further, patient medical records 115 may be used, and as will be described below, can be used in conjunction with the industry medical information and a medical professional's prescribing expertise to confirm that a patient is a good candidate for such a clinical trial, or medication administration program. These databases may be accessed in a manner known to one of ordinary skill in the art.
Once confirmed, a medication administration regimen in accordance with the clinical trial or other prescription requirements such as in a public health, medical practice environment or the like may be prescribed and entered into the system of the invention at 120. Once entered into the system, a particular prescription regimen may cause a set of user instructions, various training sequences and the like 125 to be generated and transmitted to an apparatus provided to a patient in accordance with an embodiment of the invention for access to the system of the invention. Such an apparatus may comprise a custom designed video and audio capture, analysis and transmission apparatus, a smart phone or other mobile device including a camera or other video and audio capture apparatuses, a netbook, laptop computer, desktop computer, tablet device or the like, or other computing appliance allowing for the display of instructions to a patient, and allowing for the eventual capture, analysis and transmission of video, audio and other analysis information. When installing software on a user's own hardware system, it is preferred that the software detect and otherwise test or determine that the hardware attempting to be utilized by the patient is sufficient to implement the invention and is sufficient to run a software package provided in accordance with the invention. Thus, the software may check that a camera includes sufficient resolution, that a memory of the device is of sufficient size to allow for sufficient captured video storage, that audio may be properly captured, and that the transmission system includes sufficient bandwidth to transmit and receive captured video, audio, video instructions and the like.
In a clinical trial or other administration settings, patient instructions and various training sequences may be varied for different users to determine the best set of instructions, or may be varied based upon demographics, experience, or other factors that may require different types of instructions to be provided. It is further contemplated in accordance with an embodiment of the invention that multiple clinical trials or patient populations may be managed by a manager in accordance with the invention so that the invention contemplates a medication administration system that allows for a single point of management for all clinical trials or patient management groups associated with a particular manager or the like. Such management techniques in accordance with the embodiment of the invention may further be applied to various public health situations, disease management scenarios and the like.
Such user instructions and training sequences may include general instructions about the particular medication and/or device such as an inhaler or injectable device subject to the current trial or medication administration protocol, methods for administration, warnings about side effects, and concerns about drug interactions with common substances or medications, or other medications prescribed to the patient by the system or by another medical service provider. It is contemplated in accordance with an embodiment of the invention that such set of user instructions may be interactive, allowing a user to view additional information about such instructions or prescriptions as desired. These instructions may comprise written, audio or video instructions provided to the user on a display of the user apparatus. These instruction may further comprise interactive instructions provided to a user on a device, adapting to the actions of a user, thus providing a sophisticated interactive training apparatus and system. In an inhalable system, such visual guides may include advising the user when to inhale and exhale, how long to hold their breath. The system may also advise if a location is too noisy, or has poor lighting. It is further contemplated that such instructions may indicate one or more movement sequences to be associated with a corresponding one or more medication administration sequences. A more in-depth description of the information provided at step 125 is depicted in FIG. 2.
As is shown in FIG. 2, the generation and provision of user instructions as set forth in step 125 first comprises the step of receiving a sequence of required instruction steps at step 205. This sequence may be determined as described above in step 120. The system then may confirm whether one or more of the instructions steps require the conveyance of information to a patient at step 210. These conveyance steps may comprise a more conventional instruction step, such as the display of written information, comprise a more advanced instruction step, such as the conveyance of audible information, video instructions or the like, or may comprise an interactive instruction step, such as an interactive instruction sequence displaying a desired sequence of information to a patient, and then monitoring and confirming whether the patent has properly administered the medication. Various feedback mechanisms may be provided to allow the patient to try multiple times to perform proper administration, and may also provide varying encouragement or instructions to confirm that administration training has been performed properly. Thus, such an instruction and training sequence may include the eventual capture of video, audio and other information from the user. Therefore, at step 215, it may be determined whether one or more of the instruction steps will require the capture of information from the user, thus comprising an advanced interactive training sequence. Thereafter, each of the training steps requiring capture of video information from a user is confirmed at step 220. If no further video capture is required, and therefore various training or other interactive sequences have been completed, processing for step 125 then ends at step 250. If it is determined that the capture of video and/or audio information will be required at step 220 for the current training step, then processing passes to step 230, and various instructional video, audio and other sequences may be provided to the user in an instructional sequence format.
Such interactive instructions sequence may be particularly applicable to the use of an inhaler solution in that proper positioning and use of an inhaler is particularly important. As noted above, proper angling of the inhaler device, synchronization of inhalation and actuation of the device, and proper timing of maintaining the device and inhaled breath are all factors that contribute to the efficacy of an inhalable medication. Training of patients to properly perform these actions, and further monitoring during each use, may improve the medication experience of the patient, allowing for improved outcomes using the medication.
After being shown a particular instructional sequence, preferably applicable to a particular step of a medication administration protocol sequence, then processing passes to step 235 where the user may be prompted to perform a particular action or sequence of movements. The user may request to be re-shown these sequences as many times as necessary, and may also include audio or other instructions, so that the user is provided with a training sequence, thereby reducing variability of future performance of that action. When preparing to perform these actions, an alert system may be employed to warn the patient of any issues that may interfere with the proper capture of video and/or audio information, as may take place similarly when actually administering the medication. Thus, the user may be encouraged to properly perform these sequences, thus acting as an interactive training module.
Thus, the user may be notified if they are sitting in a manner in which their actions cannot be properly captured, if they are blocked from the camera, the light conditions are insufficient, if an object they are holding is in an improper location, or the like. As is shown in FIG. 4, a box 410 may be provided on a display viewable by a patient using the system. A representation of the patient's face may be shown in a position relative to an optimal filming position for the use of, for example, an inhaler for medication administration. Thus, while facial representation 400a is properly positioned, facial representation 400b is positioned to the left of the box, while facial representation 400c is positioned down and to the right of the box. A similar positioning system may be provided for an injectable medication, the position of a patient body part being provided in place of the facial positioning described above. Thus, not only may proper positioning be determined, but use of the proper body part may also be confirmed. In practice, the box may be made a red or other warning color until proper alignment is achieved (including if a user or desired user body part is not positioned fully within a screen, the user is too close or far from the camera, or for any other reason), at which time the box may change to green or other appropriate color. Further, audio clues may also be given to the patient, such as increasing frequency beeping as the optimal position is approached. Any other positioning indicators or the like may also be employed.
Thus, in accordance with an embodiment of the present invention to be employed for inhaler medications, the user is preferably provided with immediate feedback on their position and the ability of their actions to be properly recorded and analyzed. As the user preferably interacts with the system of this embodiment of the invention, such a scheme may be employed to provide continuous feedback to the user, and thus indicating whether the system is able to properly capture and/or analyze the actions of the user. If time is passed and the user is unable to properly position themselves, or to properly perform desired actions, additional guidance may be provided to the user in order to remedy such a situation, including but not limited to directional indications, voice commands, video images of proper technique, etc.
In addition to properly positioning the patient, proper positioning of one or more objects, either absolutely or relative to another body part, may be determined, such as positioning an inhaler relative to the mouth and face of the user, an injectable medication delivery device relative to the body part of the user to receive the injection, or the like for imaging and processing in accordance with an embodiment of the invention. As is shown in FIG. 5, an inhaler 500 may be indicated as properly positioned by a box 522, the box being green, for example, as in the description of FIG. 4. Such an object, however, is more likely to be improperly positioned not only left to right and up to down, but also in distance to the imaging apparatus, in accordance with one or more limitations of the imaging device, such as the resolution thereof, low light positions, and the like, and any affect such resolution might have on the ability of the imaging device to identify shape, color text or other coding, or the like associated with the object being imaged. Thus, if positioned too far away from the imaging apparatus, a sequence of boxes 510, 511, 512 and a small representation of inhaler 500 may be provided to alert the user to move the inhaler closer. If the inhaler is not only too far away, but off center, boxes 520, 521, 522 may be provided to guide the user to move the inhaler into proper position absolutely and relative to the mouth and face of the user. Similar functionality may be provided for positioning an injectable apparatus or inhaler apparatus relative to a user body part to receive the injection, including relative angle and distance to the body part, or relative to the mouth of the user when employing an inhaler apparatus. By properly positioning such a device, the system may be employed to confirm the identity of such a medication, employing shape, color, labeling, and the like. Further, a real time tracking system may be employed that includes visual guides to properly training and guide the user as to the direction and angle of the device, such as an inhaler device, thus allowing for optimal usage. Such a real-time interactive system allows for advanced user interaction via a sophisticated user interface to communicate with, and adapt to, a user. In the case of an inhaler device, an interactive training system may therefore be provided be provided to further insure, in the case of a metered dose inhaler, that the canister has been properly inserted in to the inhaler device, may aid the user in checking the expiration date, if any, or may do so automatically, wither through text recognition or through the use of a barcode reading system. The system may further be employed to request and confirm the user actuates multiple inhalation doses, if necessary.
In addition to determining identity of the medication, such processing may be used to determine safety of the apparatus, such as whether an inhaler or injectable device may have been damaged or tampered with. Further, the medication may be observed to determine any change in color or other characteristic of the medication that may suggest spoilage, improper medication, counterfeit medication or the like. The apparatus, in accordance with an embodiment of the invention, may thus ask the user to move the inhaler or injectable device closer to or further away from the imaging apparatus, may change an ambient light sensitivity of the apparatus, or may otherwise change details of the image capture. As noted above, both color and audio prompting may be provided.
To the extent that positioning and orientation of the inhaler, injectable medication administrator or the like when being used is important, a similar system may be employed. As is shown in FIG. 6, a set of concentric circles 610a-e (or other positioning indicator) may be provided to aid in the positioning of an inhaler 600. A center circle 610e may be provided with a solid center (not shown) upon proper placement of the inhaler. These circles may move as the boxes in FIG. 5, and may further use color and/or audio prompts to instruct the user. Further, as images of inhaler positions and orientations, or inhaler and hand positions and orientations, are to be captured and analyzed, the system may also preferably indicate not only proper positioning, but actual acquisition of a correct position and orientation sequence. In accordance with an additional embodiment of the invention, such recognizable positioning and orientation may further comprise a sequence of gestures and apparatus movement and orientation employed to ensure that the patient properly administers their medication. In accordance with an administration process, as noted above, the patient may first be trained to show a particular medication administration device or apparatus in their hand to the camera for imaging and recognition. The patient may then be asked to place the apparatus at an appropriate administration location, such as against the mouth in the case of an inhaler apparatus, or at a particular body part location in the case of an injectable medication. Thereafter, actuation of the apparatus, through the process of monitoring movement and audible cues may be employed. Thus, through a predetermined sequence of actions that are captured, imaged and analyzed, evidence of proper administration can be recorded and analyzed. Visual and audio prompts to aid the user in properly positioning the inhalable device relative to the mouth of the user may also be provided.
Furthermore, in accordance with one or more embodiments of the invention, various additional aspects of medication and/or administration may be checked and confirmed. Thus, the system may employ such computer vision and activity recognition to determine a liquid color, liquid consistency or clarity, potential existence of particles, perhaps suggesting a spoiled medication, bubbles in the liquid, suggesting improper handling, in an injectable administration system. Through the use of the system, a number of administrations can be tracked, and a liquid or other level may be used to confirm the count, thus potentially allowing for the addition ordering of further medication, or other counting of inhaler administrations without the need for expensive inhaler units. Also, dosage settings, if applicable on an injectable pen or other apparatus may also be confirmed before administration.
Furthermore, as is shown in FIG. 7, when tracking the movement of a medication administration apparatus 700, it is preferable to depict to a patient whether they are holding the apparatus at a correct orientation, when the apparatus is in transit, or positioned at the administration sight. Thus, as is show in FIG. 7, an administration apparatus 700 is indicated to be reoriented from a horizontal to a vertical orientation through movement in the direction noted by arrows A. A set of guidance tracks 710a, 710b may be displayed to a patient and successive apparatus positions and orientations may be superimposed thereon. As the apparatus moves along the proscribed path, concentric circles such as those depicted in FIG. 6 may be employed to confirm proper location and orientation. Thus, in accordance with an embodiment of the invention, a virtual path may be shown to the user to ensure that the proper method of medication administration is followed. As noted above, color and/or audio sequences may also be employed. Similar positioning information may be processed relative to an injectable medication.
Therefore, in accordance with one or more of the positioning assistance schemes noted in FIGS. 4-7, a patient may be guided to properly present themselves or an object to an image capture device for capture and interpretation during the noted training phase, or (as will be described below) during a particular medication administration phase. Any of the display and notification techniques noted in any of these Figures may be used in any of the other Figures, in accordance with various embodiments of the invention. Further, these positioning techniques may be employed not only during initial training, but during any subsequent system process employing video image capture of people, objects, or any other entity to be imaged, or the use of audio information.
Thus, in one or more situations in which proper positioning of a medication administration device, such as a metered dose inhaler, dry inhaler or the like, is desired to be monitored, the relative positioning of such a device to the face of a user, for example, may be determined in order to determine whether the user is properly holding and positioning the inhaler for appropriate use. As noted above, improper placement may impede proper medication administration. Through the user of computer vision to track and determine proper placement and actuation of the inhaler, best practices can be determined and confirmed. Any malicious intent on the part of the user may be determined based upon purposeful incorrect usage determined based upon video or audio signals received and analyzed. Alerts may be sent to the user warning them on such a problem, or to a clinical trial coordinator or healthcare provider, as appropriate.
Referring back to FIG. 2, at step 240 these motions of the user may be captured and confirmed as being correct by one or more appropriate computer vision techniques, individual review by a human, or other appropriate determination process. If not correct, processing may return to step 230 to provide the instructions and example sequences again to the user. Therefore, in accordance with the invention, repeated instruction may be provided to the patient until training can be confirmed that the patient has performed the desired sequence correctly, thereby aiding in limiting future variability in the actions taken by the patient during administration. Such instruction may take the form of analysis of a recorded user action, and comments on what the user may be doing wrong, and how this action may be improved. Once the user has received sufficient instruction, and it is therefore determined that the user has performed the action in a manner that is sufficiently similar to the instruction set, and substantially consistent over a number of performances of the action, processing then passes to step 245 where it is determined whether there are additional training steps to be presented, and therefore additional video sequences to be captured. If so, processing returns to step 220 for further processing. If not, processing ends at step 250.
Referring back to the lower portion of FIG. 1, the horizontal line indicates a time for patient administration of medication. At such time, the user may be notified to take their medication through any desirable communication and notification system, including text messaging, email, telephone call, automated calendar reminder or the like. While not explicitly shown, first, preferably the identity of a user is confirmed through the use of a facial recognition sequence, other biometric identification sequence, or other password identification system. Upon recognition of the individual, the system may display one or more data regarding the individual, such as, by way of example only, name, patient status, medication to be administered, calendar indicating to the patient when medication has been administered and if any administration times have been missed, and, selectively, a score indicative of a level of compliance of the individual with the medication protocol, if desired. Once identified and notified of a type of medication to be administered, the patient may display a medication administration apparatus, such as an inhaler, injectable apparatus, or other medication form (including a pill bottle, pill, or the like) to confirm that the medication is correct and is the currently prescribed medication to be taken through the use of text recognition, medication recognition, barcode or other code reading of one or more unique identifiers from the administration apparatus, pill bottle or the like, or other appropriate medication recognition scheme. The user may alternatively be shown a virtual medicine cabinet with visual or textual indications of one or more medications to be taken, and/or one or more medication apparatuses to be employed, at a particular time. Imaging of one or more of such medication apparatuses or medications may then match a medication apparatus provided by the patient to one or more medications for use with the matched medication apparatus in the virtual medicine cabinet. Thus, the patient is not only allowed to have a particular medication apparatus imaged, but also may be given a visual representation of medications to be taken, medications that have already been taken, and a visual picture of one or more additional medications to look for if the patient is confused or is not immediately able to locate all of the required medication. Such a display may further act as an additional incentive program for the patient to properly take their medication, and may in turn give a patient other incentives, such as a running score, payment information or other point systems if the patient is to be rewarded for properly taking medication. Thus, credit to buy information from a website or store may be provided. For children, various animations may be provided, and pocket money or other credits may be provided to purchase items online or through one or more stores from supporting merchants may be provided. The display of such information may assist in convincing the patient to continue to properly take medication. Such positive reinforcement may include one or more animations or the like to encourage desirable (or discourage undesirable) behavior. Posting of success results or other information to one or more social networking sites may encourage group support to encourage medication. Chat features and the like may be employed for such encouragement. Peer networks, or other private groups of patients may be set up to allow for more open lines of communication between patients, and to allow for encouragement based upon the activities of the patient. Therefore, in accordance with the various embodiments of the invention, communication tools, including the ability to access social networking sites, peer to peer networks, private groups and the like are preferably provided with the monitoring device so that ease of use of these types of systems may be provided. This sequence of steps therefore acts as an audit trail each time a medication is taken, that can be reviewed later, to ensure that a patient is properly following a regimen. Any of the positioning schemes depicted in FIGS. 4-7 may be employed.
Additionally, after confirmation or failure of confirmation of such administration, the user may be provided with a progress report regarding how they have performed over time, and further providing encouragement for future adherence. A point system may be provided in which excellent adherence behavior may be rewarded with rewards, such as gifts and the like. These gifts are preferably geared towards particular patient populations, but may also provide points allowing the user to select a particular reward. Thus, such rewards encourage good behavior. Additionally, notice that a particular user has received a reward may be provided to the other users through the social networks or the like, thus encouraging good behavior on their part as well. Such rewards may be awarded based upon user preferences, or other demographic information or the like. A lottery type system may be provided in which a number of users reaching a particular percentage of adherence, or by some other metric, may be entered into a lottery for a great reward. Rewards may also be somewhat randomized, thus allowing users to be surprised as to what they may receive. Additionally, notice of a next administration time may be provided, along with one or more messages from a healthcare provider regarding protocol changes, or other desired information.
Furthermore, use of a combination of visual and/or audio cues may be employed to further determine sequence and timing. Thus, not only should an inhaler be properly positioned, for example, but during use, an inhalation by the patient should occur immediately after actuation of the inhaler. Thus, by visually and/or audibly confirming first actuation, and then inhalation, this sequence of actions can be confirmed. Sound and visual signatures related to each of these actions may be employed to improve a confidence with which the system is able to confirm proper administration. Similarly, an injectable may need to be properly positioned and maintained in a particular position after administration, such as maintenance of a needle after actuation of the injection mechanism for a predetermined period of time.
In accordance with the invention, confirmation of patient adherence to the prescribed administration schedule for the medication as prescribed by the clinical trial or other prescription regimen may be determined. While such confirmation may take a number of forms, in accordance with the invention, a preferred method for such confirmation may include capturing a video and audio sequence of the patient actually administering the medication. In a further preferred method, such a sequence for such confirmation may include employing a facial recognition sequence or other biometric confirmation that a particular patient is in fact receiving treatment, but may also provide for the ability to obscure the face or other identifying feature of a user, or otherwise encrypt such information to allow for the storage and use of such images while protecting the identity of the patient, a technique that may be beneficial when a medication administration manager is providing a general report about a clinical trial, and not trying to remedy a situation with a particular patient, or in particular in a public health or disease management scenario. Activity recognition, gesture recognition, utilizing computer vision or the like, or other feature for determining whether a particular subject movement meets a predefined movement sequence may be employed to be sure that the patient is properly taking prescribed medication.
Referring next to FIG. 3, a method in accordance with an additional embodiment of the present invention for performing audio and video capture and recognition of adherence to a prescribed protocol is described, as set forth in steps 130 and 135 of FIG. 1. In FIG. 3, a patient may first log into the system of the invention at step 305, employing the facial recognition, biometric recognition, password entry, or other patient identification method, and at step 310 proper medication is confirmed as noted above, through the user of bar code reading, text recognition, visual recognition employing video or still image recognition, or other medication recognition technique. The patient may be reminded to log onto the system to take their medication through any type of reminder, such as a text message, email, phone call, automated alarm or the like. Of course, any of the positioning techniques previously described in reference to FIGS. 4-7 may be employed. Next, at step 315 it may be confirmed that the process involved will include one or more information capture steps, and at step 320 it may be determined whether these information steps will include video capture. If not, video processing ends after storage of any non-video information. (Alternatively, steps 315 and 320 may be excluded if it is determined that each confirmation sequence may employ video capture, then video processing may pass directly to step 325, as described below.) If it is confirmed at step 320 that one or more steps will include video and/or audio capture, processing then passes to step 325 where the user may be prompted to perform one or more predetermined actions, these actions being captured. Positioning of the inhaler, injectable medication apparatus, or other medication may be performed in accordance with any of the techniques as described previously in reference to FIGS. 4-7. Such recognition in the case of an injectable or inhalable administration apparatus may also comprise confirming relationship of the injectable or inhalable administration apparatus and a prescribed body part, proper actuation of the administration apparatus, including inhalation in the case of an inhalable administration apparatus, maintaining the administration apparatus in the location for a predetermined period of time, and perhaps proper post administration action, such as cleaning and storing the apparatus, refrigerating the apparatus, cleaning an injection site and the like. Further, voice recognition may be utilized to allow the user to enter commands, and an audio output may be provided for aiding the user in properly adhering to instructions from the system. Additional audio cues may be recognized, such as upon visual confirmation of administration of an injectable or inhalable medication, audio signatures may be employed in order to determine whether insufficient pressure may have been used, or whether a sufficient or extensive period of time has passed from actuation to inhalation. Additionally, audio signatures may be employed to confirm that the inhalable material was properly inhaled, and not blocked, for example, by the teeth of the user. Proper capture of patient actions is very important as the patient only administers the medication once per capture period.
As is further described below, such audio inhalation may be employed with micro lung movement recognition to further improve confidence that a correct administration action has taken place. It is therefore contemplated in accordance with an embodiment of the invention that any such video or visual analysis may include the use of micro movements to aid in determining inhaler or other apparatus actuation. In particular, small movements in the jaw or chest may be employed to aid in determining whether or not medication from an actuated inhaler is actually being inhaled. Any number of such micro movements may be employed, from movement of one or more portions of the medication administration device, and body parts that are to move based upon proper medication administration or the like. Such body part movement may additionally include, in the case of use of an inhaler, movement of the head of the user, movement of the hand of the user. Changes in the relative positioning of the inhaler and the mouth or other facial portion of the user, and the like. These micro movements may be used alone, or in combination with other visual and audio cues to confirm proper medication administration. Further, such movements may be employed to aid in determining an amount of medication that has been inhaled, or otherwise ingested. Audio and visual duration of inhalation and micro movements may be considered objectively, and in relation to prior inhalation activities of a user to determine changes in patterns thereof. A measured inhalation system may be first provided to allow the system to “learn” how a proper inhalation looks and sounds, using this as a reference to judge later inhalation instances. Various demographic and other patient related data may further be employed in order to determine an amount of medication that should be inhaled or otherwise ingested or injected by a user. Thus, a larger individual should have a longer inhalation cycle, and a deeper inhalation breath, for example, than a smaller child. Other demographic information, such as age, etc. may also be used to properly calibrate the systems.
Video capture analysis may then begin at step 330, such analysis comprising analysis of the newly captured video and/or audio, as provided as noted above with respect to FIG. 2. At step 335 it may be determined whether the action has been properly captured, and whether the captured action has been properly analyzed by the system. Various incentives may be provided to the patient to encourage them to take their medication properly. Thus, in addition to providing various reminders to a patient as is known in the art, points, monetary or other incentive may be provided to the user for actually having medication administration confirmed. Further proper administration with less errors, etc. may be rewarded more highly, thus giving incentive for the patient to concentrate on administration issues and to attempt to have such administration be as accurate and consistent as possible. Such incentives and medication tracking may be used to determine future courses of treatment or payment. For example, if a patient consistently fails to take medication as required, perhaps a different course of treatment requiring fewer medication administrations may be better for this patient. Alternatively, if a medication requires a consistent administration and is very expensive, failure to comply with administration instructions may be cause for an insurance company, prescribing doctor or the like to not renew such a prescription for the patient, thus saving money in a situation where the money was being wasted because of lack of compliance.
If it is determined that administration of the medication did not take place properly, processing may return to step 325 and the user may be once again prompted to perform the action. Of course, if this process involves actual administration of inhaler or injectable medication, it may not be proper to request re-performance of the action, unless it can be determined that the user did not actually administer the medication. If the action has been properly captured, and is able to be analyzed, processing passes to step 345 where it may be determined whether additional captures are required. If so, processing returns to step 320. If no further captures are required, processing ends at step 350 where the various captured video sequences are stored. These stored sequences may also be made available for human review and involvement, when it is determined that this would be beneficial.
Therefore, in accordance with various embodiments of the invention, because a video image of the patient actually administering an inhalable or other medication (or other method of medication administration, including but not limited to injections, dialysis, and any other medication administration procedure) may be captured and analyzed, actual confirmation may be achieved, rather than simply relying on the patient to state that a particular medication was administered. Such a video image may be captured or stored in any appropriate format given a selected type of activity or gesture recognition that is employed in accordance with a particular embodiment of the invention. Such may include full video, biometric data points, recording of movement of an article, such as a bracelet or the like, affixed to the patient or administrator, use of mapping to provide a stick figure or other body movement tracking technique, or gesture or activity recognition to determine movement or the like. The user may be encouraged to use a particular sequence of movement to be confirmed that they are properly administering the medication according to the protocol, thus reducing the possibility of the potential appropriate movements considered to be “correct.” Or, as noted above, capture of customized video sequences may be performed so that the user is more likely to repeat these same actions. Indeed, various instructional videos or other appropriate training may be provided to a user to insure they properly administer the medication.
This captured adherence information may be provided to a healthcare provider, clinical trial manager or the like through a dashboard allowing for the review of information about an individual patient, entire population of patients, or demographically relevant information. Such information may be provided to easily notify the healthcare provider, clinical trial manager or the like of problem patients, demographic groups, medications or the like. One or more dashboards or other reporting mechanisms may be employed as described in copending U.S. patent application Ser. No. 13/189,518, filed Jul. 24, 2011 to Hanina et al., titled “Method and Apparatus for Monitoring Medication Adherence”, the entire contents thereof being incorporated herein by reference. Thus, any adherence or other information obtained in accordance with the present invention may be provided to one or more individuals in accordance with one or more methods or systems as described in the '518 application.
Through the use of training as described above, a type of administration language may be generated, allowing for extension to other patients, and also allowing for interpretation of reason for differences from a predefined sequence by a patient. Thus, if a patient performs an action differently over time, this difference may provide insight to a reaction to a medication, changes in the patient's medical condition, or the like. It is further anticipated that analysis of large numbers of patients will allow for a more flexible system that may recognize more of a patient's movements, and thus may improve the ability of the system to function properly.
Therefore, in accordance with an embodiment of the invention, a user may perform a predetermined sequence of actions designed to ensure performance of medication administration. Thus, by way of example only, for an inhaled medication as noted above, the user may be asked to first show a medication and may then be prompted to position the medication administration apparatus relative to their mouth in a desired manner. Next the user may be prompted to administer the medication, the action of administration being captured on video and audio, and being interpreted to confirm that the medication has been properly administered. Of course, in accordance with this embodiment of the invention, other action sequences may be employed, and may be mixed with other actions to be performed by a patient or caregiver. Thus, but defining a medication adherence protocol as a single or sequence of gestures that may be recognized by a processing system, the accuracy of confirming that a patient has actually taken a particular medication is improved. Through an interactive learning process, the processing system may also learn patient behaviors to be more accurately determine medication adherence, and to remove some of the potential false positives or false negatives. If a caregiver is involved, it is contemplated that the caregiver be provided with a number of gestures indicative of particular actions to be taken, and use of these gestures prompting the system to confirm that these actions are in fact being taken. Thus, a full audit trail of not only the patient, but also the caregiver may be determine, such as whether they approached the patient at the correct times, or that they washed their hands when approaching.
Further in accordance with an inhalable medication administration apparatus, such as a metered dose inhaler or dry inhaler, the use of audio signatures in addition to visual cues may be beneficial. Therefore, in accordance with an embodiment of the invention, an inventive audio cue recognition system may be employed. In such an embodiment, a standard audio analysis and recognition system may be employed. Such an analysis system can typically easily distinguish sounds associated with proper administration of inhalable medication in a relatively quiet environment (i.e. an environment without substantial background noise). The inventors of the present invention have determined that such a system has a high accuracy rate of about 95%, and only includes a 1% false positive error. Such an analysis system includes to modules, a first for feature extraction of audio features, and a second for classification of the extracted sounds. Preferably the feature extraction module may employ Mel-Frequency Cepstrum Coefficients (MFCC) as feature points. Thereafter, SVM machine learning may be employed for the classification module. While the system is relatively simple and fast, and thus easy to integrate into other systems and is easily used in real time, it may not be sufficiently robust in a noisy environment.
Therefore, in addition to this type of audio recognition system, the inventors of the present invention present a multiple level sound recognition system, for use of detection of audio signatures in accordance with inhaler use in the present invention. Of course, such a multiple level sound recognition system may be employed in any medical or other application. Therefore, in accordance with this embodiment of the invention, a first level recognition is performed similar to that of the above embodiment in which sounds are determined to have passed a first filter. It is desirable to set this level to be inclusive, rather than exclusive, so that sounds that are clearly no related to inhaler audio signatures be excluded, but sounds that may be audio signatures are included. Such recognition system may also be employed to other sound in administration, such as confirming proper installation of a medication canister, for example.
After determining a plurality of signals that have passed the first level filter, these passed sounds are then preferably used to train a second level filter. Because all of these sounds have passed the first level filter, the sounds will be relatively similar. Thus, because the range of sounds will be narrower, the precision of this second level filter will be far greater. By training the system to recognize inhaler sounds form background noise, only employing sounds that passed a first level filter, precise determination of inhaler sounds can be achieved. Of course, and number of levels may be employed in order to improve precision of the system, but at the expense of training and processing time.
FIG. 8 depicts operation of a combined video and audio detection system for detecting proper actuation and use of an inhaler medication. As is shown in FIG. 8, a step 805 asks the user to position their face is provided, allowing for facial identification or the like as described above. During this time, an audio detection system is preferably receiving sound in a microphone at step 810, is performing an environmental check to determine whether there is too much noise to perform a proper audio analysis at step 820, and if it is too noisy, issuing a warning at step 824. Once the face positioning and facial recognition step is completed, processing on the video side passes to step 815, where proper positioning of the inhaler apparatus is performed, utilizing one or more of the positioning systems described above. In addition to proper positioning, this step may also be used to properly identify the inhaler, medication or the like. During this time frame, steps 810, 820 and 824 as described above are performed to continue to look out for situations in which there are too much noise to perform a proper audio analysis.
The dashed line in FIG. 8 depicts a time for providing an instruction for actuation of the inhaler device. Thus, on the video side, at step 825 proper actuation of the inhaler based upon video evidence is provided. Procedures for this have been described above, and will be described in greater detail below. At the same time, step 830 is performed on the audio side to make a determination of whether an audio signature is indicative of proper actuation of the inhaler apparatus. Details of this audio determination will be described below. Upon proper determination of actuation of the inhaler apparatus by video in step 825 and by audio in step 830, it can be determined, to some level of confidence, that the inhaler apparatus has been properly actuated.
Referring next to FIG. 9, the audio signal confirmation steps shown in FIG. 8 in accordance with an embodiment of the present invention will now be more particularly described. In the process for determining medication adherence, and during video steps before inhaler apparatus actuation, sound is received at a microphone at step 910. This sound information is stored in a byte array at step 912. Next, at step 920, an environmental checker performs a check of the noise in the signal. If at step 922 it is determined that that it is too noisy, a warning is provided at step 924 to instruct the user that it is too noisy, and to find another location that is perhaps less noisy. Processing then returns to step 910 to receive additional sound to determine whether the sound situation has improved. If at step 922 it is determined that it is not too noisy, then processing similarly returns to step 910 to continue to listen for sound to determine whether the sound environment has deteriorated.
After steps 805 and 815 in FIG. 8 have been completed, the system will instruct the user to actuate the inhaler apparatus, a time indicated by the dashed line in FIG. 9. At this time, processing will pass from step 922 to step 930 where a sound of actuation is recorded, and the data associated with such sound of actuation is normalized and type transformed. Processing then passes to step 940 where the sound is preprocessed. Then, at step 950, a first level SVM model is applied to the data (as described above) to determine whether a recorded sound is possibly a target sound. If the inquiry at step 955 is answered in the negative, the recorded sound is determined not to be the target sound, and it is concluded that the sound is not that of an inhaler at step 957.
If on the other hand, the inquiry at step 955 is answered in the affirmative, and it is determined that the recorded sound is possible the target sound, processing then passes to step 960 in which a second level SVM model is applied (as described above). This second level model, as noted, is more precise than the first level, and is able to do so because all clearly incorrect sounds have been removed. Thus, this second level processing can be more precise and sensitive, focusing on nuanced differences between the various sounds. At step 965, it is inquired whether this second level SVM model has indicated that the recorded sound is the target sound. If this inquiry is answered in the negative, and it is determined that the sound is therefore not the sound of the actuation of an inhaler, such an indication is made at step 967. If on the other hand, the inquiry at step 965 is answered in the affirmative, and it is once again determined that the recorded wound is similar, to the desired level of precision, to the target sound, it is indicated at step 970 that an inhaler actuation sound has been detected. This result, along with any results from the video analysis system, may therefore be used to determine proper inhaler actuation.
Additional features may be employed in accordance with encouragement and determination of proper inhaler actuation. In one particular embodiment, if a particular amount of time is to pass after inhalation before exhalation, a countdown timer or other time measuring processing may be displayed on the display of a monitoring device to properly instruct the user to hold their breath. Such graphical or audible information may be tailored to the population at issue, such as a whimsical treatment may be provided for a younger, child population, while a more standard countdown clock may be provided for adults.
In addition to simply determining whether the recorded sound (recorded in step 930 of FIG. 9) is an inhaler actuation, it may be desirable to further segment this determination into classifications of inhaler actuation. The inventors of the present invention have determined that one error often made by users of inhaler devices is to sometimes block the flow of air and medication with their teeth. Therefore, in accordance with an alternative embodiment of the invention, another level may be provided to determine a difference between actuation with teeth in the way and actuation without teeth in the way. By training the audible recognition system to differentiate between these two sounds, proper identification can be determined. In such a manner, if it is determined that the teeth of the user are in the way, the user may be congratulated for using the device, and provided further instruction to remove their teeth from the flow of air. These two determinations will place the system in different states, and any desired action may be performed based upon the current state of the system.
Similar systems may also be employed to determine, via audio and video cues, whether the inhaler has been held incorrectly, or is being held away from the user's mouth, for example. Such audio may aid when a camera placed directly in front of a user, may still recognize a proper inhalation. Changes in perspective for the video system may also be suggested based upon past and/or current audio and video analysis. Thus, alerts may be more confidently employed in accordance with misuse of the system when the inhaler or other device is improperly used.
In an alternative embodiment of the system, noise cancellation may be employed in accordance with the environmental checker of FIGS. 8 and 9. Thus, rather than simply rejecting a particular environment as too noisy, an analysis of the noise characteristics may be provided. This analysis may be further employed to determine whether a noise cancellation operation may reduce background noise to a point where such environment may be acceptable. If so, a warning may still be provided, or alternatively, the warning may be overridden as the system may operate properly with use of the noise cancellation system.
In addition to segmenting the inhalation audio signature into two classes, one with teeth in the way and one without teeth in the delay, any number of additional classifications may be provided. In a particular embodiment of the invention, the amount of air inhaled may be segmented, so that, for example, the sound of a high volume of air intake may be differentiated from the sound of a low volume of air intake. This may be valuable to determine objectively whether enough air has been inhaled, or may be used in a sequential manner to determine whether an air intake profile for a particular user changes over time, or from one administration to another.
Further uses of the video capture sequences may also be employed, including video capture of responses to questionnaires about current patient states of discomfort, informed consent, example of questions to be asked, video transmission of such questions and the like. The patient may be able to send a video message, pointing to a particular pain or the like, and may include an audio portion as well. Time stamp markers may also be captured to confirm that the user is taking their medication at appropriate times and a number of times a user has taken a particular medication, to confirm whether there are substantial delays between instruction and administration, or for any other time sequence determination. Furthermore, other behavioral markers, such as, by way of example only, shaking hands indicating a particular ailment, or other movements by a patient that may give a hint as to the physical or mental status thereof. Additionally, if the user is taking medication that is improper, or they have already taken, a warning may be provided to warn the user to stop medication administration immediately.
In accordance with various embodiments of the invention, when considering administration of an inhalable or injectable medication, analysis of adherence video sequences may be employed to determine a likelihood that a patient has actually administered their medication. Thus, based upon video and audio cues determined related to positioning and use of the medication administration apparatus, it may be determined that the patient is having problems properly positioning the apparatus, and therefore the system is unsure that the patient has administered the medication properly. Low confidence in proper administration based upon failure to properly position the apparatus, failure to record audio signals indicative of proper administration or the like may be employed to determine whether a patient should be retrained, via the automated training system described herein, by automated contact, or by individual personal contact. This determination of low confidence of administration, even if it is ultimately determined that administration likely took place, may still be utilized to determine whether training or other actions may be taken. Such confidence levels may be used, in accordance with a desired algorithm or the like, to provide an overall picture of medication administration by a patients or group of patients, thus allowing for intervention, encouragement, training or the like to be provided when it appears that actions are changing, but not necessarily waiting until a critical issue is discovered. Furthermore, if low confidence is determined, further, more robust continuous tracking systems may be employed to confirm that the hand of the user moves correctly, that the inhaler is properly placed in the hand of the user, that the inhaler is placed properly relative to the face and mouth of the user, that the inhaler is properly placed relative to the lips of the user, and that the canister is properly placed within the inhaler.
It is further contemplated that the method and apparatus of the invention allow for integration with one or more audio or video conferencing systems, thus receiving and/or providing information there through. Thus, a user may employ a standard video conferencing tool or system, and have this information be coupled to a mobile or other device being used in accordance with an embodiment of the present invention.
Therefore, in accordance with the invention, a method and apparatus are provided that allow for the automated confirmation of adherence to administration protocol for medication, and provide for a most sophisticated method for confirming and studying methods of administration of such prescription medication.
It will thus be seen that the objects set forth above, among those made apparent from the preceding description, are efficiently attained and, because certain changes may be made in carrying out the above method and in the construction(s) set forth without departing from the spirit and scope of the invention, it is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
It is also to be understood that this description is intended to cover all of the generic and specific features of the invention herein described and all statements of the scope of the invention which, as a matter of language, might be said to fall there between.

## Claims

1. A medication administration confirmation apparatus for confirming administration of medication employing an inhalable medication administration apparatus, comprising:
a display operable to display one or more instructions for instructing proper placement of the inhalable medication administration apparatus including at least instructions for properly positioning the inhalable medication administration apparatus at a correct angle relative to a body of a user during use thereof;
a video capture device operable to capture one or more video sequences of the user administering medication employing the inhalable medication administration apparatus;
an audio capture device operable to capture one or more audio sequences of the user administering medication employing the inhalable medication administration apparatus;
a memory operable to receive, from the video capture device, and store the one or more video sequences, and to receive from the audio capture device, and store the captured one or more audio sequences; and
a processor operable to analyze at least one of the stored video sequences and at least one of the stored audio sequences to confirm that the user has properly administered the medication with the inhalable medication administration apparatus, including at least whether the user had properly positioned the inhalable medication administration apparatus at a correct angle relative to the body of the user during use thereof and to cause to be displayed on the display a second set of one or more visual instructions further instructing proper placement and use of the inhalable medication administration apparatus, including at least instructions for properly positioning the inhalable medication administration apparatus at the correct angle relative to a body of the user during use thereof, if analysis of the at least one of the stored video sequences and the at least one of the stored audio sequences confirms that the user has not properly administered the medication with the inhalable medication administration apparatus.

2. The medication confirmation apparatus of claim 1, wherein the processor is operable to generate and output an audio or visual prompt to perform a particular sequence of actions to be stored as the one or more video sequences.

3. The medication confirmation apparatus of claim 2, wherein the audio capture device is operable to store the one or more audio sequences as the particular sequence of actions are performed by the user.

4. The medication confirmation apparatus of claim 2, wherein the particular sequence of actions is designed to assist in determining proper medication administration.

5. The medication confirmation apparatus of claim 1, wherein the processor is operable to analyze the one or more audio sequences to determine their similarity to a target audio sequence.

6. The medication confirmation apparatus of claim 5, wherein the processor is operable to analyze the one or more audio sequences in a two level process, comprising:
determining whether one of the one or more captured audio sequences passes a first filter as being similar to a target audio sequence; and
subsequent to determining that the one or more captured audio sequences passes the first filter, determining whether the one or more captured audio sequences passes a second more stringent filter as being similar to the target audio sequence.

7. The medication confirmation apparatus of claim 6, wherein the processor is operable to train the more stringent filter of the second step based upon audio sequences that pass the first filter.

8. The medication confirmation apparatus of claim 1, wherein
the processor is further operable to analyze the at least one of the stored video sequences and at least one of the stored audio sequences to confirm proper positioning of the inhalable medication administration apparatus.

9. The medication confirmation apparatus of claim 1, wherein the processor is operable to analyze the at least one of the stored video sequences and the at least one of the stored audio sequences during an interactive training sequence.

10. The medication confirmation apparatus of claim 1, wherein the processor is operable to analyze the at least one stored video sequences to determine one or more micro movements of the user.

11. The medication confirmation apparatus of claim 1, wherein the processor is operable to analyze the one or more captured audio sequences to determine an amount of medication inhaled by the user.

12. The medication confirmation apparatus of claim 1, wherein the processor is operable to analyze the one or more captured audio sequences to determine whether the teeth of the user are in the path of inhalation.

13. The medication confirmation apparatus of claim 1, wherein the processor is operable to determine whether there is too much background noise in the at least one of the stored audio sequences to properly capture the one or more audio signals.

14. The medication confirmation apparatus of claim 13, wherein the processor is further operable to apply a noise cancellation algorithm to the one or more captured audio signals.

15. A medication confirmation method for confirming administration of medication employing an inhalable medication administration apparatus, comprising:
displaying on a display one or more instructions for instructing proper placement of the inhalable medication administration apparatus including at least instructions for properly positioning the inhalable medication administration apparatus at a correct angle relative to a body of a user during use thereof;
capturing, by a video capture device, one or more video sequences of a user administering medication employing the inhalable medication administration apparatus;
storing the captured one or more video sequences;
capturing, by an audio capture device, one or more audio sequences of the user administering medication employing the inhalable medication administration apparatus;
storing the captured one or more audio sequences;
analyzing, by a processor, at least one of the stored video sequences and at least one of the stored audio sequences to confirm that the user has properly administered the medication with the inhalable medication administration apparatus, including at least whether the user had properly positioned the inhalable medication administration apparatus at a correct angle relative to the body of the user during use thereof; and
displaying on the display a second set of one or more instructions further instructing proper placement and use of the inhalable medication administration apparatus, including at least instructions for properly positioning the inhalable medication administration apparatus at the correct angle relative to a body of the user during use thereof, if analysis by the processor of the at least one of the stored video sequences and the at least one of the stored audio sequences confirms that the user has not properly administered the medication with the inhalable medication administration apparatus.

16. The method of claim 15, further comprising outputting, from the processor, an audio or visual prompt to the user to perform a particular sequence of actions to be stored as the one or more video sequences.

17. The method of claim 16, further comprising storing the one or more audio sequences in accordance with the performance of the particular sequence of actions.

18. The method of claim 15, further comprising analyzing, by the processor, the at least one captured audio sequence to determine a similarity to a target audio sequence.

19. The method of claim 18, wherein analyzing the at least one captured audio sequence comprises:
determining whether the at least one captured audio sequences passes a first filter as being similar to the target audio sequence; and
when the at least one captured audio sequence passes the first filter, determining whether the one or more captured audio sequences passes a more stringent filter as being similar to the target audio sequence.

20. The method of claim 19, further comprising training the more stringent filter based upon audio sequences that pass the first filter.