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The smart medical refrigerator

Article  in  IEEE Potentials · March 2005


DOI: 10.1109/MP.2005.1405802 · Source: IEEE Xplore

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David L. Livingston James C. Squire


Virginia Military Institute Virginia Military Institute
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During the past century, the life alone combined with increasingly com- would alert a healthcare provider, or
expectancy in the United States has plex medical dosing has increased the family member, if the patient does not
increased by more than 50% due to need for home healthcare providers. access his or her medicine in a timely
advances in medicine. There is a direct However, supply and demand are fashion.
relationship between the increase in life not working with each other like eco- Commonly prescribed medicines
expectancy and the percentage increase nomic theory would lead us to believe. such as benazepril (to reduce blood
of the elderly population. According to Montana Congressman Denny Rehberg pressure), metoprolol (to prevent car-
the Office for the Aging, “The most reports that as the demand increases diac attack), gluophage (for Type II dia-
rapid growth nationally between 2000- “for in-home healthcare providers and betes) and insulin (for Type I diabetes)
2015 is expected to occur among the community health center are all excellent candidates for such a
oldest and frailest. The 85+ cohort will nurses…Nursing degree graduation device. Each one must be taken multi-
grow 28.2%, from 4.3 million to 19.4 rates have plummeted…most recently ple times every day. Thus, the medicine
million.” falling over 7% while demand for the dispenser can warn family members
This rise in the elderly population life saving care they provide is project- within hours of patient incapacitation.
introduces new medical and sociologi- ed to grow 21% in the next few years.” Unlike radio-linked health monitors
cal challenges to society. Dr. Home healthcare services are fre- (“I’ve fallen down and I can’t get up!”),
Blakowski, director of the Palliative quently unaffordable or unavailable. monitoring patient access to medicines
Care Unit at the VA in Pittsburgh, states, Families with elderly relatives, who can- is passive; it does not require patients
“It isn’t uncommon at all to have not afford such a person, must make to wear radio transmitters, or be con-
scious to activate them.
We have developed such a monitor-
The Smart Medical Refrigerator ing device that stores insulin. This is a
commonly prescribed medication. The
Paul Kuwik! Thomas Largi! Matt York! Centers for Disease Control and
Prevention estimate that 18.2 million US
! adults have diabetes. Insulin must be
Dennis Crump! David Livingston and James C" Squire refrigerated. What’s more, elderly dia-
betics have elevated risk factors for a
number of incapacitating diseases that
makes them particularly vulnerable if
living alone.

Smart medical
refrigerator concept
The Smart Medical Refrigerator (Fig.
1) monitors the use of insulin by diabet-
ic patients and can alert a physician or
family members if the patient does not
access the medicine in a set time frame.
It is reliable, costs a fraction of the
expense of home nursing care (the pro-
totype was fabricated for less than
Front and back photo of the Smart Medical Refrigerator prototype $250), alerts the family or physician
quickly in an emergency, and provides
patients with 10 to 15 different drug time to assure the safety of their relative emotional security to the elderly patient
prescriptions and some with up to 40 by themselves. Unfortunately, families living alone.
different drug prescriptions.” These cannot usually afford the time or The Smart Insulin Refrigerator is
large numbers are hard to track for any expense of frequent calls each day. connected to a standard telephone line.
patient, however it can be further com- And, in the case of a fall or a stroke, a A microcontroller monitors the refriger-
plicated by senile dementia and few hours may mean the difference ator door’s position. If the door is not
Alzheimer’s syndrome that is expected between life and death. As a result, opened within a programmable time
to rise 27% by 2020. There is also con- these folks are at-risk of fatal complica- period, a modem within the refrigerator
cern that a temporary incapacitation tions from minor accidents because of dials an internet service provider (ISP),
caused by a fall, stroke, Transient lack of monitoring. Elderly diabetics establishes a simple mail transfer proto-
Ischemic Attack (a temporary blockage are particularly at risk from a host of col (SMTP) connection to the mail serv-
of an artery within the brain) or illness diabetes-related health complications. er, and sends an email alert to any
may turn fatal if left untreated. The fact that elderly patients often number of designated contacts such as
Social changes and geographical must take medications around the clock the doctor, a family member, and
mobility are also contributing to the suggests that a method to monitor their neighbor. The message may be sent
higher and higher numbers of elderly continued usage would be beneficial. directly to an email account, or may be
living alone without nearby family. One way would be to use a “smart” formatted to send a text message to a
Rising numbers of elderly people living medicinal dispenser. This monitor cell phone, or a beeper alert through a

42 0278-6648/05/$20.00 © 2005 IEEE IEEE POTENTIALS


for internet access, not a network drop.
External
120V AC to Power Module
12V DC Design
The refrigerator has four major sys-
tems: the refrigerator, the power mod-
12V DC 5V DC
Power ule, the battery strength module and the
12V DC to
Control microcontroller module. The prototype
5V DC
Logic refrigeration unit itself was modified
120V AC
Wall Power from a commercially available portable,
Battery Battery solid-state 12V picnic refrigerator by
Battery Strength Strength replacing its power supply with the bat-
Logic LEDs tery-backup unit and by wiring in a
Battery Strength Module door sensor.
Battery Power management system. 120V AC
Recharging from a standard wall socket powers the
Logic 12V DC
management system and is connected
Refrigerator directly to the 120V AC to 12 VDC con-
verter, 16A regulated power supply, the
battery charger and a relay that forms
the battery-backup logic (Fig. 2). To
Door Door Open eliminate the inconvenience of having
Microcontroller Module LED to remove batteries to charge them, a
Sensor
charger was added that automatically
switches between fast and trickle-charg-
Internet
Time ing modes. A relay automatically routes
Remaining Debug Mode
Microcontroller power from the wall socket or the bat-
LEDs Select
tery backup. The battery has sufficient
energy to power the system for 1.5
5V DC hours.
Telephone Battery strength module. Battery
ISP Modem
Jack
strength is monitored using four com-
parators (Fig. 3). The regulated 5V
Fig. 1 The Smart Medical Refrigerator is source powering the microcontroller is
composed of four major systems: effect transducer (a common type of dropped using adjustable resistor
the refrigerator, the power module, magnetic field sen-
the battery strength module, and
sor) can be activated 120VAC DPDT Relay
the microcontroller module.
externally by placing
a magnet in a partic- 120V AC
paging service. ular orientation on
This refrigerator incorporates several the control box
design features including: which puts the unit Battery
• Battery backup: It provides power into debug mode. Recharger
to both the refrigerator and microcon- This mode speeds
12V, 7A
troller during blackouts; it also ensures the clock by a factor
Gelcell
alert messages are sent even if a power of 1,000. This Battery
glitch occurs during data transmission. enables testing with- To Batt.
• Automatic recharge: While the out opening the Strength Batt. Output
refrigerator is connected to the house enclosure. The hid- Module
current, the battery will be automatical- den nature of the 120V AC
ly recharged if necessary, or trickle- switch makes it to
charged, to maintain peak energy. unlikely that the 12V DC
• Battery level indicator: Light-emit- patient will acciden- To
Refrigerator, 12V DC
ting diodes (LEDs) display the time tally activate it. This UPS
Modem
remaining until the battery goes dead feature simplifies on-
when battery backup is in operation. site testing and To Micro- 12V DC
• Simple status indicators: Color- demonstration. Controller 5V DC to
coded LEDs on the refrigerator control • Convenience: Module 5V DC
unit indicate if the patient has recently The smart medical
taken insulin (green) (open the refriger- refrigerator is easily Fig. 2 The power module ensures an uninter-
ator door), is due for a dose (yellow), is movable since it weighs only 25 ruptible 12VDC is available to power
overdue (red), or if an alert has been pounds. Its dimensions are 12x11x11 the refrigerator and electronics. The
sent (flashing red). inches. Also, the refrigerator only module switches between AC and bat-
tery power as needed, and automatical-
• Debug mode switch: A small Hall- requires a standard RJ-11 telephone
ly keeps the batteries fully-charged.

FEBRUARY/MARCH 2005 43
12V (Battery) to-next-insulin-injection accordance with her recommendations,
with color coded LEDs, we changed the direction of the
984 740 door-open status, and increasing time from the last insulin
whether or not an injection from left to right and changed
5V (Regulated) alarm message was sent the LED type to high-output white
with a blinking LED. units.
Although programmed Overall the patient found the device
1k 220 for insulin timing, it can useful and asked to keep the unit after
be reprogrammed using the trial ended, noting that she found
2k + an externally accessible the feedback that the refrigerator's tim-
− serial adapter for any ing lights provided especially helpful.
68k medicine’s dosing The advising doctor, whose undergrad-
schedule and to send uate degree is in electrical engineering,
alerts to any email suggested we add a date and time code
15k address or pager num- to the information transmitted. He
220
ber in any number of noted that the unit could be fooled if
2k + different formats. the patient did not shut the door, so the
− microcontroller code was modified to
68k Field testing begin timing from the door open event,
After reviewing a rather than the door close.
prototype refrigerator,
18k 220 our coordinating doctor Conclusions
located a diabetic As both the percentage and absolute
2k + patient to field test and numbers of elderly living alone climb to

provide critical feed- record levels, novel approaches to geri-
68k back on our prototype. atric healthcare must be taken. The
After testing the Smart Smart Medical Refrigerator is one such
Medical Refrigerator for approach. Perhaps it's greatest signifi-
40k a week, the patient cance is that although there are a num-
220
noted two problems ber of active-sensor units on the market
20k + with the prototype: that require patient interaction to send
1) Several times the out an alarm (for instance the pop-icon

patient partially opened "I've fallen and I can't get up" device by
the refrigerator that the Home Alert), the concept of using a
Hall-Effect sensor failed passive sensors to automatically sense
Fig. 3 The battery strength module dis- to detect. In the second design phase, patient incapacitation can be easily gen-
plays whether the battery can
the sensor was repositioned for greater eralized. At-risk patients who do not
power the refrigerator and elec-
tronics for 90, 45, 30, or 15 addi- sensitivity. take medication could be monitored
tional minutes. 2) Our patient had difficulty inter- using the same device attached to a
preting the LED time indicators. In standard household refrigerator, a pres-
dividers to measure four specific battery sure sensor on a carpet, a
voltages. These voltage trip points are Battery Discharge Curve
motion sensor in the
not selected at evenly-divided voltage 12 kitchen, or even a tilt sen-
increments, but rather correspond to 90, sor on a toilet seat. In this
45, 30 and 15 minutes of remaining bat- way the unit could help
10
tery power determined experimentally address the broader societal
(Fig. 4). The patient can graphically need of remote, automatic
read the time remaining by viewing 8 well being monitoring.
LEDs on the top of the control box.
Volts (V)

Microcontroller module. The micro-


6
Acknowledgments
controller (Fig. 5) monitors the patient’s The authors wish to
usage of the refrigerator. The processor express their appreciation
(PIC16F628) has an internal timer that 4 to Wetmore Research Grant
monitors the time since the refrigerator from the Virginia Military
was last opened. If the cascaded coun- 2 Institute and our advising
ters reach a preset time (for testing it physician Joseph M. Troise,
was set to 16 hours), the processor M.D. We also wish to
communicates to the modem to format 0 thank Mrs. Joyce Reid for
0 10 20 30 40 50 60 70 80
and send an email to the designated Time (minutes) her helpful comments dur-
contact(s). Each time the refrigerator ing patient testing.
Fig. 4 Experimentally-measured battery voltage dis-
door opens, an interrupt is generated charge curve, showing the location of comparator
that resets the counters. The processor trip points at voltages corresponding to 90, 45, Read more about it
controls the LEDs displaying the time- 30, and 15 minutes remaining. • Department of Health

44 IEEE POTENTIALS
and Human Services, Centers for design, and foreign travel. He is an hands-on engineering in industry. Matt
Disease Control and Prevention, active member of the IEEE and is cur- served as the chair of the IEEE student
“National Diabetes Fact Sheet,” 2003. rently the student section secretary, and section in his senior year at the
• Rehberg, D., “Congress Acts to is a member of ΠHΣ. He plans to enter Institute. He is also a member of TBΠ
Address Nursing Crisis,” address to the flight school upon graduation and and O∆K.
House of Representatives, Washington become an F16 pilot in the US Air Dennis Crump is in his third year at
DC, May 8, 2002. Force after graduation. the Virginia Military Institute and has
• Steuben Integrated Planning, Thomas Largi is in his fourth year at interests in radio frequency communi-
“Adult Services Planning,” the Virginia Military Institute. He is a cations. He is a member of the IEEE
http://www.ihsnet.org/SIP_Profiles/ member of the IEEE and has served as and is also a member of the TBΠ and

To Door Switch
+5 220Ω To Modem Door Switch 220Ω +5
To Modem 1 (A2) (A1) 18
220Ω NC NC
2 (A3) (A0) 17
220Ω NC (Schmitt) NC
3 (A4) (A7) 16
220Ω NC (MCL) LED_Door Open
4 (A5) (A6) 15
5 (Vss) (Vdd) 14
220Ω Debug Mode LED0_8
6 (B0) (B7) 13
220Ω Door Switch Polarity LED8_12
7 (B1) (B6) 12
NC LED12_16
8 (B2) (B5) 11
NC LED_Alarm
9 (B3) (B4) 10
220Ω

Fig. 5 The microcontroller module is built around a PIC16F628, and controls the LED status
indicators and modem. ΠHΣ honor societies. Upon
graduation he plans to enter the
Adult_Services.pdf, 4, 2004. an officer for the student branch. He U.S. Navy under the Nuclear Propulsion
• Thompson, T., “Consumers & Food plans to enter the U.S. Air Force as a Officer Candidate Program and become
2003: New Challenges, New Solutions,” developmental engineer in their a naval officer on a nuclear-powered
National Food Policy Conference. advanced weapons program. submarine.
Washington DC, 8 May 2003. Matthew York is a 2004 graduate of Dave Livingston and Jim Squire are
the Virginia Military Institute and is cur- professors in the Department of
About the authors rently employed as an Engineering Electrical and Computer Engineering at
Paul Kuwik is in his fourth year at Leadership Development Program the Virginia Military Institute. More
the Virginia Military Institute and has Associate at Lockheed-Martin in information on them can be found at
interests in bioengineering, sensor Northern Virginia. His interests include <www.vmi.edu/ece>.

Working on the project

A team of four undergraduate electrical engineering students advised by a biomedical engineer, a computer
engineer, and a physician designed the medical Internet-aware insulin refrigerator for an independent study pro-
ject. The idea for the device came from one of the team members who had a concern about his elderly mother’s
health. The project ran over two semesters.

During the first semester, the students formulated design criteria and decomposed the problem into four subsys-
tems: mechanical design, power supply, analog interfacing and microcontroller interfacing. Each student was
responsible for a subsystem. After review, a prototype was constructed, debug and field-tests were conducted,
and modifications were made.

During the second semester, the students devoted their efforts to enhancing the prototype, documenting intellec-
tual property, and publicizing the device. They submitted a patent application, received a patent pending and
are currently marketing the licensing rights for the device. —PK, TL, MY, DC, DL & JCS

FEBRUARY/MARCH 2005 45

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