Abstract:
A method and system for interaction with a community of individuals, relating to compliance with and effectiveness of treatment regimens, including supply and use of pharmaceuticals, using a protocol or other intelligent message which acts in place of a service provider and which is capable of collecting or imparting information to patients in place thereof. Individuals interact with the protocol or intelligent message to provide assistance in all aspects of treatment regimen compliance, data collection, supply or delivery, review and modification.

Description:
RELATED APPLICATIONS 
     This application is a continuation of application Ser. No. 11/845,317, filed Aug. 27, 2007, now U.S. Pat. No. 8,015,033, which is a continuation of application Ser. No. 10/233,296, filed Aug. 30, 2002, now U.S. Pat. No. 7,970,620, which is a continuation in-part of application Ser. No. 09/304,447, filed May 3, 1999, now abandoned. All of the above-identified applications are incorporated herein by reference in their entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to interaction with a community of individuals, relating to treatment regimen compliance and efficacy, including supply and use of pharmaceuticals. 
     2. Related Art 
     When medical personnel prescribe treatment regimens for patients or “patients” undertake non-prescription treatment regimens (whether such regimens are prescribed or undertaken for medication, physical therapy, psychological therapy, self-improvement, or other purposes), a problem can arise in assuring that the patients comply with the requirements of the treatment regimen. For example, some patients are disorganized, forgetful, or simply unwilling to comply. When the treatment regimen has potential side effects, or when the treatment regimen is to be followed under stated conditions (for example: taking medicine with meals, not with alcohol, or in the evening), patient compliance can be relatively reduced even further. When the treatment regimen is relatively complex, some patients are even unable or unwilling to manage that treatment regimen. 
     Known methods for monitoring and controlling treatment regimens are relatively costly and limited in capability. Some known methods are described in the following patents: 
     U.S. Pat. No. 5,408,443, “Programmable Medication Dispensing System,” issued Apr. 18, 1995 in the name of Edward D. Weinberger. 
     U.S. Pat. No. 5,642,731, “Method of and Apparatus for Monitoring the Management of Disease,” issued Jul. 1, 1997 in the name of Bruce A. Kehr. 
     U.S. Pat. No. 5,752,235, “Electronic Medication Monitoring and Dispensing Method,” issued May 12, 1998 in the name of Bruce A. Kehr, et al. 
     While these known methods generally achieve the goal of monitoring and controlling a treatment regimen, particularly a medication regimen, they suffer from several drawbacks and limitations. 
     First, there is a need to provide a portable system to monitor and encourage compliance, and facilitate data collection, so that patients are restricted as little as possible regarding their activities and movements. 
     Second, there is a need to determine if patients are actually complying with treatment regimens at times when the patients are relatively remote to client devices for the system. Known methods do not provide adequate feedback to determine whether patients are complying with the treatment regimen unless they remain relatively local to client devices. 
     Third, there is a need to determine whether treatment regimens have the desired and intended effects. Known methods do not provide adequate feedback to determine whether treatment regimens are effective, or whether patients are suffering any untoward side effects. Using known methods, medical personnel must generally wait for patients to complain, or for medical tests to show, that prescribed treatment regimens are inadequate or are producing side effects. Similarly, using known methods, patients undertaking non-prescribed treatment regimens generally do not have effective or convenient systems to monitor and record whether non-prescribed treatment regimens are producing intended results. 
     Fourth, there is a need to inform patients to follow treatment regimens, particularly when patients are forgetful or treatment regimens are complex. Although known methods do include reminders to patients, it would be advantageous to tailor those reminders to patients&#39; actual compliance history (thus, providing fewer reminders when they are relatively less necessary and more reminders when they are relatively more necessary). 
     Fifth, there is a need to leverage expert knowledge to improve response to feedback from patients, and to reduce the time and expense required for medical personnel to individually monitor, evaluate and modify treatment regimens. 
     Sixth, there is a need to broaden application of reminder and expert knowledge leveraging systems beyond medication regimens, to include physical, psychological, self-improvement and other treatment regimens. 
     Accordingly, it would be advantageous to provide a portable device that can be coupled and uncoupled to a communication system with feedback to monitor patient compliance with, and effectiveness of, treatment regimens, so that input from patients regarding treatment regimens can be recorded, reviewed, analyzed and otherwise generally acted upon. Medical personnel and/or patients can thus (1) monitor compliance with treatment regimens, (2) monitor effectiveness or side effects of treatment regimens, (3) remind patients no more than necessary, and (4) possibly alter treatment regimens in response to feedback from patients. These advantages are achieved in embodiments of the invention in which a portable device is intermittently coupled to a client device in a client-server system, the patient enters information to the portable device about following the treatment regimen while the portable device is uncoupled, and medical personnel or the patient can receive that information and possibly alter the behavior of the portable device when the portable device is re-coupled to the system. 
     SUMMARY OF THE INVENTION 
     The invention provides a method and system for interaction with a community of individuals, relating to compliance with and effectiveness of treatment regimens, including supply and use of pharmaceuticals, using a protocol or other intelligent message which acts in place of a service provider and which is capable of collecting or imparting information to patients in place thereof. Individuals interact with the protocol or intelligent message to provide assistance in all aspects of treatment regimen compliance, data collection, supply or delivery, review and modification. These aspects can include (1) reminders regarding compliance with a selected treatment regimen for medication, physical therapy, psychological therapy, self-improvement, or some combination thereof, (2) data collection of facts regarding patient compliance, symptomology, possible drug interactions or side effects of medication if required by the treatment regimen, and other facts relevant to evaluation and possible modification of the treatment regimen; (3) networked integration with workstations for medical professionals to automate approvals and modifications, and refills and delivery of medication if required by the treatment regimen. 
     A system includes a set of client devices and a server device. A service provider determines a treatment regimen for selected patients, determines a protocol to be followed by the client devices to assist the patient in complying with that treatment regimen [in assisting with that medication regimen] and to maximize effectiveness of treatment, and sends that protocol to the server device. The server device can update (responsive to the protocol) selected instructions at the client devices, and can receive (responsive to selected instructions) information from the client devices regarding their associated patients. 
     In a first preferred embodiment, a client device, located locally to a patient, couples to a portable device (such as a cellular telephone, pager, “Palm Pilot” or other handheld computer, or watch), capable of being carried away by the patient to locations relatively remote from the client device. The client device can interact with the portable device: (1) to provide the portable device with the capability of reminding the patient regarding the treatment regimen, or (2) to provide the portable device with the capability of further data collection regarding the patient. The client device can interact with the portable device using a docking connection, an infrared connection, a radio-frequency connection, a plug-in connection, or another suitable connection. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  shows a block diagram of a system for interaction with a community of individuals to encourage and monitor compliance with a treatment regimen, using a protocol or other intelligent message which acts in place of a service provider to collect and impart information relevant to the treatment regimen; 
         FIG. 2  shows a process flow diagram of a method for operating a system for interaction with a community of individuals to encourage and monitor compliance with a treatment regimen, using a protocol or other intelligent message which acts in place of a service provider to collect and impart information relevant to the treatment regimen; 
         FIG. 3  shows a first preferred embodiment of a portable device used by the system to encourage and monitor compliance with a treatment regimen, and to collect and impart information relevant to the treatment regimen; 
         FIG. 4  is a perspective view of a remotely programmable apparatus; and 
         FIG. 5  is a block diagram illustrating the components of the apparatus of  FIG. 4 . 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     In the following description, a preferred embodiment of the invention is described with regard to preferred process steps and data structures. Embodiments of the invention can be implemented using general purpose processors or special purpose processors operating under program control, or other circuits, adapted to particular process steps and data structures described herein. Implementation of the process steps and data structures described herein would not require undue experimentation or further invention. 
     System Elements 
       FIG. 1  shows a block diagram of a system  100  to encourage and monitor compliance with a treatment regimen using a protocol or other intelligent message which acts in place of a service provider to collect and impart information relevant to the treatment regimen, including a patient device  110 , a pharmacist device  140 , a medical professional device  150 , and a server device  160 , said devices being coupled using a communication network  130 , and a portable device  112  which can be coupled to the patient device  110  to receive information regarding the treatment regimen and send feedback from the patient  111  responsive thereto. 
     For further information regarding a data structure and simplified patient interaction interface, and preferred embodiments of the patient device  110 , pharmacist device  140 , medical professional device  150 , and the server device  160  including database  161  of treatment regimen information, see related application Ser. No. 09/201,323, Express Mail Mailing No. EE143637591US, filed Nov. 30, 1998, in the name of Stephen J. Brown, titled “Leveraging Interaction with A Community of Individuals,” assigned to the same assignee, and other related applications incorporated by reference therein. 
     For further information regarding the protocol or other intelligent message used by the system, see related application Ser. No. 09/203,882, Express Mail Mailing No. EE143637565US, filed Dec. 1, 1998, in the name of Stephen J. Brown, titled “Remote User Data Collection Protocols Including Data Structures and User Interface,” assigned to the same assignee, and other related applications incorporated by reference therein. 
     For further information regarding a medicine dispenser which can be used by the system, see related application Ser. No. 09/203,880, Express Mail Mailing No. EE143637557US, filed Dec. 1, 1998, in the name of Stephen J. Brown, et al., titled “Using A Computer Communication System With Feedback to Dispense Medicine,” assigned to the same assignee, and other related applications incorporated by reference therein. 
     Portable Device 
       FIG. 3  shows a first preferred embodiment of a portable device  112  used by the system  100 . 
     In a first preferred embodiment, the portable device  112  includes a coupling element  113  for coupling the portable device  112  to the patient device  110 , a memory element  114 , a processor chip  115  including a clock circuit  116 , a presentation element  117 , and a patient feedback input element  118 . 
     A service provider determines a treatment regimen for selected patients  111  and a protocol to be followed by their portable devices  112  to assist the patients  111  in following the treatment regimen. The service provider sends the treatment regimen and protocol to the server device  160  where it is recorded in the database  161 . The server device  160  sends the treatment regimen and protocol information to the patient device  110 , and optionally to the pharmacist device  140  and the medical professional device  150 . 
     The portable device  112  is coupled to the patient device  1   10  using the coupling element  113 . The coupling element  113  may couple using a docking station, an infrared connection, a radio-frequency connection, a plug-in connection, other suitable means or any variant thereof. 
     While coupled, the treatment regimen and protocol information received by the patient device  110  is sent to the portable device  112  and recorded in the memory  114 . In a first preferred embodiment, the power source  119  is rechargeable and the charge can be replenished by the patient device  110  while the portable device  112  is coupled to it. In alternative embodiments, the power source  119  is rechargeable and the charge can be replenished by some other device, or includes one or more disposable batteries. 
     After the treatment regimen and protocol information is recorded in the memory  114 , the portable device  112  can be uncoupled from the patient device  110  and taken with the patient  110  to locations relatively or logically remote from the patient device  110 . Whether the portable device  112  coupled or uncoupled to the patient device  110 , when the patient  111  is due to perform an act according to the treatment regimen, the portable device  112  uses the presentation element  117  to provide a reminder message instructing the patient  111  to perform that act. In a first preferred embodiment, the act to be performed is related to compliance with a medication regimen including, without limitation, obtaining medicine, taking medicine, taking medicine with another substance such as food or water, not taking medicine with another substance such as alcohol or incompatible medications, or obtaining a prescription refill. In alternative embodiments, the act to be performed may be pursuant to a physical therapy regimen including, without limitation, exercising, stretching, changing position, or changing work routine; pursuant to a psychological therapy regimen including, without limitation, repeating an affirmation, meditation, self-hypnosis or other mental activity; or pursuant to a self-help regimen or other type of treatment regimen such as weight loss including, without limitation, drinking water or eating a snack. 
     The patient  111  performs the indicated act and enters a message into the portable device  112  confirming performance of the act using the patient feedback input element  118 . Operation of the patient feedback input element  118  causes the processor chip  115  to cancel the reminder message, check the clock  116 , and record the time and fact of performance in the memory  114 . In a first preferred embodiment, the patient  111  also enters additional information relevant to monitoring and evaluating the treatment regimen in response to queries by the presentation element  117  in accordance with the treatment regimen and protocol. 
     The number of reminder messages provided to the patient  111 , and the number of messages from the patient  111  confirming performance of the indicated acts and/or providing other information relevant to compliance with and effectiveness of the treatment regimen, is limited only by the memory capacity of the portable device  112 . 
     In a first preferred embodiment, the presentation element  117  is a human-readable visual display using LCD&#39;s, LED&#39;s, or other suitable devices. In alternative preferred embodiments, the presentation element  117  can be a device which produces human-intelligible sound, or a combination of devices which produce human-intelligible visual and audible signals. 
     At some later time, the portable device  112  is re-coupled to the patient device  110  using the coupling element  113 , causing the contents of the memory  114  to be downloaded into the patient device  110  and sent to the server device  160  for recording in the database  161 . Such a time may be as is convenient to the patient  111 , or according to a selected maximum time interval dictated by the treatment regimen and protocol, or as is required to replenish the power source  119  of the portable device  112 , or in accordance with other requirements of the system  100 . 
     At the server device  160 , the protocol or other intelligent message reviews and compares the information provided by the patient  111  to the requirements of the treatment regimen in order to evaluate the effectiveness of the treatment regimen towards achieving treatment objectives and as to compliance of the patient  111  with the treatment regimen. The protocol may then leave the treatment regimen unchanged or modify it as needed to increase effectiveness and/or compliance; in either case, the server device  160  sends a message to the patient device  110  as to the regimen to be followed from that time forward. In a preferred embodiment, the server device  160  also sends that message to the pharmacist device  140  and the medical professional device  150 . For additional information regarding the protocol used by the system  100  and interaction of the protocol with other elements of the system  100 , see discussion above at System Elements regarding related applications. 
     In a first preferred embodiment, information regarding the entire course of the treatment regimen, such as each updated regimen and its effectiveness and relative compliance by the patient can be stored by each of those devices and displayed on demand. In alternative embodiments, only the server records the entire course, or only selected devices, or some combination thereof. 
     In a preferred embodiment, when a treatment regimen requires a patient  111  to take one or more medications, the portable device  112  can be coupled to a medication dispenser containing medication specified by the treatment regimen. In an alternative embodiment, the portable device  112  also controls the medication dispenser so as to release only the correct dosage of the correct medication at the correct time responsive to the treatment regimen. In a further alternative preferred embodiment, the dispenser automatically provides feedback to the portable device  112  when the correct medication is removed, canceling the reminder message and storing the feedback for subsequent downloading to the patient device  110  on the next occasion that the portable device  112  is coupled to the patient device  110 . 
     The patient device  110  can be any device for electronic communication including, but not limited to, an application specific device, a hard-wired telephone, a cellular telephone, a pager, a personal desktop computer, a personal notebook computer, a hand-held computing device, an Internet appliance, an internet-enabled television such as WebTV, personal digital assistant such as the Palm III, or any variant thereof. 
     The portable device  112  can be any portable device for electronic communication which is capable of being coupled to the patient device  110  including, without limitation, an application specific device, a cellular telephone, a pager, a personal notebook computer, a hand-held computing device, an internet appliance, a personal digital assistant such as the Palm III, a watch, or any variant thereof. 
     The feedback input element  118  can be any means of providing input to an electronic communication device including, but not limited to, a button, a telephone key, a computer keyboard key, a voice-response activator, or any variant or combination thereof. 
     Method of Operation 
       FIG. 2  shows a process flow diagram of a method for operating a system for leveraging expert interaction with a community of individuals to encourage compliance with a treatment regimen and for collecting and imparting information relevant to that treatment regimen. 
     A method  200  is performed by the system  100 , as follows: 
     At a flow point  201 , the system  100  is ready to proceed. 
     At a step  202 , a service provider enters information concerning a treatment regimen and protocol to be followed by the patient  111 . 
     At a step  203 , the treatment regimen and protocol information is sent to the server device  160  using the communications network  130 . 
     At a step  204 , the server device  160  records the treatment regimen and protocol information received from the service provider in the database  161 . 
     At a step  205  in a preferred embodiment, the server device  160  sends the treatment regimen and protocol information to the patient device  110 , the pharmacist device  140  and the medical professional device  150  using the communication network  130 . In alternative embodiments, the server device  160  may send the treatment regimen and protocol information only to the patient device  110 . 
     At a step  206 , the portable device  112  is coupled to the patient device  110  and the treatment regimen and protocol information is copied into the memory  114  of the portable device  112 . 
     At a step  207 , the portable device  112  is uncoupled from the patient device  110  and is taken with the patient  111  to a location relatively remote from the patient device  110 . 
     At a step  208 , responsive to the treatment regimen and protocol information stored in the memory  114  in conjunction with input from the clock  116 , the patient device  110  uses the presentation element  117  to provide a reminder message to the patient  111  that an act is required to be performed by the patient  111  and instructs the patient  111  regarding the act to be performed. 
     At a step  209 , the patient  111  performs the indicated act as directed. 
     At a step  210 , the patient  111  operates the feedback input element  118  on the portable device  112 , canceling the reminder message. 
     At a step  211 , the portable device  112  uses the presentation element  117  to query the patient  111  to provide information responsive to the protocol for evaluating the effectiveness of the treatment regimen. 
     At a step  212 , the patient  111  operates the feedback input element  117  to provide information responsive to the queries, and that information is recorded in the memory  114 . 
     At a step  213 , the portable device  112  is re-coupled to the patient device  110 . 
     At a step  214 , the information stored in the memory  114  is sent to the patient device  110 , which in turn sends that information to the server device  160  using the communication network  130 . 
     At a step  215 , the information received by the server device  160  is recorded in the database  161 . 
     At a step  216 , in a preferred embodiment the server device  160  sends the information received from the patient device  110  to the pharmacist device  140  and to the medical professional device  150  using the communication network  130 . In an alternative embodiment, the server device  160  does not send the information received from the patient device  110  to the pharmacist device  140  or to the medical professional device  150 , whether using the communication network  130  or otherwise. 
     At a step  217 , the information received by the server device  160  from the patient device  110  is evaluated by the protocol. 
     At a step  218 , the protocol updates the treatment regimen and either leaves it unchanged or modifies it in accordance with the protocol logic. 
     At a step  219  in a preferred embodiment, the server device  160  sends the updated treatment regimen information to the patient device  110 , to the pharmacist device  140  and to the medical professional device  150 , using the communication network  130 . In an alternative embodiment, the server device  160  does not sent the updated treatment regimen information to the pharmacist device  140  or the medical professional device  150 . 
     At a step  220  in a preferred embodiment, the pharmacist  141  and/or the medical professional  151  review and compare the original treatment regimen, the compliance and other information input by the patient  111 , and the updated treatment regimen, and either leave the updated treatment regimen and protocol information unchanged or modify it as necessary. In an alternative embodiment, step  220  does not take place. 
     At a step  221  in a preferred embodiment, the treatment regimen and protocol information as unchanged or as modified by the pharmacist  141  and/or the medical professional  151  is sent to the server device  160  using the communication network  130 . In an alternative embodiment, step  221  does not take place. 
     At a step  222 , the server device  160  records the treatment regimen and protocol information as unchanged or as modified by the pharmacist  141  and/or the medical professional  151  in the database  161 . In an alternative embodiment, step  222  does not take place. 
     At a step  223  in a preferred embodiment, the server device  160  sends the treatment regimen and protocol information as unchanged or as modified by the pharmacist  141  and/or the medical professional  151  to the patient device  110  using the communication network  130 . In an alternative embodiment, step  223  does not take place. 
     At a step  224 , the patient device  110  sends the updated treatment regimen information to the portable device  112  and it is recorded in the memory  114 . 
     At a step  225 , the patient device  110  replenishes the charge of the power source  119 . 
     At a step  226 , the patient  111  uncouples the portable device  112  from the patient device  110 . 
     At a step  227 , the pharmacist  141  provides a refill or new medicine to the patient  111  responsive to the treatment regimen and protocol information. In an alternative embodiment, step  227  does not take place. 
       FIGS. 4-5  show the structure of an apparatus  26  according to the preferred embodiment. The remotely programmable apparatus has a communication device, such as a modem, for receiving the script programs from the server and for transmitting the responses to the server. The remotely programmable apparatus also has a user interface for communicating the query sets to the individuals and for receiving the responses to the query sets. In the preferred embodiment, the user interface includes a display for displaying the query sets and user input buttons for entering the responses to the query sets. In an alternative embodiment, the user interface includes a speech synthesizer for audibly communicating the query sets and a speech recognizer for receiving spoken responses to the query sets. 
     The remotely programmable apparatus also includes a memory for storing the script programs and the responses to the query sets. The remotely programmable apparatus further includes a microprocessor connected to the communication device, the user interface, and the memory. The microprocessor executes the script programs to identify the individual, communicate the query sets to the individual, receive the responses to the query sets, and transmit the responses to the server through the communication network. 
     In one embodiment, the system also includes at least one monitoring device for producing measurements of a physiological condition of the individual and for transmitting the measurements to the apparatus. The monitoring device can also be used to help the remotely programmable apparatus identify the individual. The remotely programmable apparatus includes a device interface connected to the microprocessor for receiving the measurements from the monitoring device. The measurements are stored in the memory and transmitted to the server along with the individual&#39;s identity and the responses to the query sets. The server also preferably includes a report generator connected to the database for generating a report of the measurements and responses. The report is displayed on the workstation. 
     As the present invention has multi-user capabilities, it must identify each individual or individual type in order to select the correct script program. In one embodiment, the individual can enter his or her unique identification code into the remotely programmable apparatus. The code is sent to the server and used to determine which script program to send back to the apparatus. 
     In another embodiment, the system uses a data card, which contains information about an individual&#39;s identity. The remotely programmable apparatus includes a data card reader in which the data card can be placed and read. A personal identification number (PIN) can also be used in conjunction with the data card in order confirm an individual&#39;s identity. In this embodiment, the present invention resembles an ATM machine. 
     In yet another embodiment, the system utilizes a biometric information gathered using a biometric sensor to determine an individual&#39;s identity. The biometric information is used by the methods and systems of the invention to assign script programs, to customize script programs for the identified individual and to provide security against unauthorized use for either or both the remote apparatus and server systems. Examples of biometric information useable by the invention include: retina metrics, iris metrics, voice print metrics, body measurement metrics, handwriting metrics, body odor metrics, heart beat signature metrics and biometrics that may be discernable from the individual&#39;s body fluids such as blood, urine or breath. 
     Table 1 shows an exemplary listing of script commands used in the preferred embodiment of the invention. 
     
       
         
               
             
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 SCRIPT COMMANDS 
               
             
          
           
               
                 Command 
                 Description 
               
               
                   
               
               
                 CLS: {LF} 
                 Clear the display. 
               
               
                 ZAP: {LF} 
                 Erase from memory the last set of 
               
               
                   
                 query responses recorded. 
               
               
                 LED: b {LF} 
                 Turn the LED on or off, where b is 
               
               
                   
                 a binary digit of 0 or 1. An argument 
               
               
                   
                 of 1 turns on the LED, and an argument 
               
               
                   
                 of 0 turns off the LED. 
               
               
                 DISPLAY: {chars}{LF} 
                 Display the text following the 
               
               
                   
                 DISPLAY command. 
               
               
                 INPUT: mmmm{LF} 
                 Record a button press. The m&#39;s 
               
               
                   
                 represent a button mask pattern for 
               
               
                   
                 each of the four input buttons. Each 
               
               
                   
                 m contains an “X” for disallowed 
               
               
                   
                 buttons or an “O” for allowed buttons. 
               
               
                   
                 For example, INPUT: OXOX {LF} allows 
               
               
                   
                 the user to press either button #1 or 
               
               
                   
                 #3. 
               
               
                 WAIT: {LF} 
                 Wait for any one button to be 
               
               
                   
                 pressed, then continue executing the 
               
               
                   
                 script program. 
               
               
                 COLLECT: device {LF} 
                 Collect measurements from the 
               
               
                   
                 monitoring device specified in the 
               
               
                   
                 COLLECT command. The user is 
               
               
                   
                 preferably prompted to connect the 
               
               
                   
                 specified monitoring device to the 
               
               
                   
                 apparatus and press a button to 
               
               
                   
                 continue. 
               
               
                 NUMBER: aaaa {LF} 
                 Assign a script identification code 
               
               
                   
                 to the script program. The script 
               
               
                   
                 identification code from the most 
               
               
                   
                 recently executed NUMBER statement is 
               
               
                   
                 subsequently transmitted to the server 
               
               
                   
                 along with the query responses and 
               
               
                   
                 device measurements. The script 
               
               
                   
                 identification code identifies to the 
               
               
                   
                 server which script program was most 
               
               
                   
                 recently executed by the remote 
               
               
                   
                 apparatus. 
               
               
                 DELAY: t {LF} 
                 Wait until time t specified in the 
               
               
                   
                 DELAY command, usually the prescribed 
               
               
                   
                 connection time. 
               
               
                 CONNECT: {LF} 
                 Perform a connection routine to 
               
               
                   
                 establish a communication link to the 
               
               
                   
                 server, transmit the patient or 
               
               
                   
                 patient type identification code, 
               
               
                   
                 query responses, device measurements, 
               
               
                   
                 and script identification code to the 
               
               
                   
                 server, and receive and store a new 
               
               
                   
                 script program. When the server 
               
               
                   
                 instructs the apparatus to disconnect, 
               
               
                   
                 the script interpreter is restarted, 
               
               
                   
                 allowing the new script program to 
               
               
                   
                 execute. 
               
               
                   
               
             
          
         
       
     
     The script commands illustrated in Table 1 are representative of the preferred embodiment and are not intended to limit the scope of the invention. After consideration of the ensuing description, it will be apparent to one skilled in the art that many other suitable scripting languages and sets of script commands may be used to implement the invention. 
     Referring to  FIG. 4 , apparatus  26  includes a housing  62 . Housing  62  is sufficiently compact to enable apparatus  26  to be placed unobtrusively on a pharmacy counter or check stand counter. Apparatus  26  also includes a display  64  for displaying queries and prompts to the patient. In the preferred embodiment, display  64  is a liquid crystal display (LCD). 
     Four user input buttons  70 A,  70 B,  70 C, and  70 D are located adjacent display  64 . User input buttons  70 A,  70 B,  70 C, and  70 D are for entering in apparatus  26  responses to the queries and prompts. In the preferred embodiment, user input buttons  70 A,  70 B,  70 C, and  70 D are momentary contact push buttons. In alternative embodiments, user input buttons  70 A,  70 B,  70 C, and  70 D may be replaced by switches, keys, a touch sensitive display screen, or any other data input device. 
     Three monitoring device jacks  68 A,  68 B, and  68 C are located on a surface of housing  62 . Device jacks  68 A,  68 B, and  68 C are for connecting apparatus  26  to a number of monitoring devices  28 , such as blood glucose meters, respiratory flow meters, or blood pressure cuffs, through respective connection cables (not shown). Apparatus  26  also includes a modem jack  66  for connecting apparatus  26  to a telephone jack through a standard connection cord (not shown). Apparatus  26  further includes a visual indicator, such as a light emitting diode (LED)  74 . LED  74  is for visually notifying the patient that he or she has unanswered queries stored in apparatus  26 . 
     Apparatus  26  also contains a data card reader  63 . Data card reader  63  is capable of reading a data card  65  containing information about a patient. In the present invention, data card  65  contains the patient&#39;s identity, condition or disease, and possibly prescription information. Data card  65  is placed in data card reader  63 , thus allowing apparatus  26  to identify the patient and assign script program  40 . Apparatus  26  also has a printer port  67 , allowing apparatus  26  to be directly connected to a printer. Queries  94 , responses  42 , device measurements  44 , and other pertinent information stored on apparatus  26  can be printed directly. 
     The apparatus also includes a biometric sensor  71  for gathering biometric information from the user. Examples of biometric sensors that may be used by the apparatus  26  include an optical device (e.g., a camera created from a CCD), a silicon sensor (e.g., a chip that gathers information using the capacitance occurring as a result of a body part coming into contact with the silicon chip), a sound sensor (e.g., a microphone), an olfactory sensor (e.g., an “artificial nose”) and/or a sensor for measuring three dimensional biometric topology (e.g., a laser or ultrasound measuring device). The type of biometric sensor  71  used in an embodiment of the invention corresponds to the type of biometric information used by the methods of the invention. 
     The present invention may use any type of biometric information gathering and analysis as described herein or known to those skilled in the art. Biometric information includes information that when used alone or in combination with other information uniquely identifies an individual with reasonable certainty. Examples of biometric information include: retina metrics, iris metrics, voice print metrics, body measurement metrics, handwriting metric, body odor metrics, heart beat signature metrics and biometrics that may be discernable from the individual&#39;s body fluids such as blood, urine or breath. Retina metrics make use of individual blood vessel patterns on the retina of the eye which are photographed, encoded, and compared to a previously coded “enrollment.” Iris metrics similarly refer to individualized patterns in the iris of the eye which are photographed, encoded, and compared to a previously coded “enrollment.” Voice print metrics capture a sample of an individual voice which reflect the physical structure producing the voice and the developmental speech patterns. Body measurement metrics map the physical measurement of the body and may include the physical characteristics of a finger, a hand, a face or other parts of the body. Handwriting metrics may include not only a comparison of the handwriting to a know sample, but also characteristics such as the speed, stroke order and pressure associated with, for instance, a signature. Use of physiological measurements as biometric information is discussed in more detail below. 
       FIG. 5  is a schematic block diagram illustrating the components of apparatus  26  in greater detail. Apparatus  26  includes a microprocessor  76 , and a memory  80  connected to microprocessor  76 . Memory  80  is preferably a non-volatile memory, such as a serial EEPROM. Memory  80  stores script programs  40  received from server  18 , measurements  44  received from monitoring device  28 , responses to queries, and a patient or patient type&#39;s unique identification code. Unique information for identifying the individual may also be stored in the memory  80  of the apparatus  26 , by the server  18 , or both. This unique information may include a unique identification number or biometrics information about the individual that uniquely identifies that individual. Microprocessor  76  also includes built-in read only memory (ROM) which stores firmware for controlling the operation of apparatus  26 . The firmware includes a script interpreter used by microprocessor  76  to execute script programs  40 . The script interpreter interprets script commands which are executed by microprocessor  76 . 
     The script commands allow apparatus  26  to identify the patient or patient type through user buttons  70 A,  70 B,  70 C, and  70 D, monitoring device  28 , data card  65 , or printer port  67 . They also allow apparatus  26  to display the query sets to the patient, receive responses  42  to the query sets, receive measurements  44  from monitoring device  28 , and transmit responses to server  18 . Specific techniques for interpreting and executing script commands in this manner are well known in the art. 
     Microprocessor  76  is preferably connected to memory  80  using a standard two-wire I 2 C interface. Microprocessor  76  is also connected to user input buttons  70 A,  70 B,  70 C, and  70 D, data card reader  63 , printer port  67 , LED  74 , a clock  84 , and a display driver  82 . Clock  84  indicates the current date and time to microprocessor  76 . For clarity of illustration, clock  84  is shown as a separate component, but is preferably built into microprocessor  76 . Display driver  82  operates under the control of microprocessor  76  to display information on display  64 . Microprocessor  76  is preferably a PIC 16C65 processor which includes a universal asynchronous receiver transmitter (UART)  78 . UART  78  is for communicating with a modem  86  and a device interface  90 . A CMOS switch  88  under the control of microprocessor  76  alternately connects modem  86  and interface  90  to UART  78 . 
     Modem  86  is connected to a telephone jack  22  through modem jack  66 . Modem  86  is for exchanging data with server  18  through communication network  24 . The data includes script programs  40  which are received from server  18  as well as responses  42  to queries, device measurements  44 , script identification codes, and the patient or patient type&#39;s unique identification code or other information that uniquely identifies the individual which modem  86  transmits to server  18 . Modem  86  is preferably a complete 28.8 K modem commercially available from Cermetek, although any suitable modem may be used. 
     Device interface  90  is connected to device jacks  68 A,  68 B, and  68 C. Device interface  90  is for interfacing with a number of monitoring devices, such as blood glucose meters, respiratory flow meters, blood pressure cuffs, weight scales, or pulse rate monitors, through the device jacks. Device interface  90  operates under the control of microprocessor  76  to collect measurements  44  from the monitoring devices and to output the measurements to microprocessor  76  for storage in memory  80 . In the preferred embodiment, device interface  90  is a standard RS232 interface. For simplicity of illustration, only one device interface is shown in  FIG. 4 . However, in alternative embodiments, apparatus  26  may include multiple device interfaces to accommodate monitoring devices  28  which have different connection standards. 
     The monitoring device  28  may include a biometric sensor  79  in lieu of or in addition to a biometric sensor  71  made part of the apparatus  26 . In addition to the types of biometric sensors  71  discussed above, a biometric sensor  79  may utilize or augment the data gathered by the monitoring device  28 . For example, the biometric sensor  79  may make use of a heartbeat signature obtained by a pulse rate monitor, the blood characteristic obtained using a blood glucose meter, or the signature antigens present in a device reading a urine sample. 
     ALTERNATIVE EMBODIMENTS 
     Although preferred embodiments are disclosed herein, many variations are possible which remain within the concept, scope, and spirit of the invention, and these variations would become clear to those skilled in the art after perusal of this application.