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A literature review is always necessary in any research. It provides a platform on which the research can dig current knowledge, methodological contributions and theoretical underpinnings Based on this, the research considers secondary materials, which provide a background on significant studies that can be linked to the research topic. The review shall touch on the understanding of IoT, user requirements linked to IoT and applicable features associated to the pill dispenser.
The study of Internet of Things attracts a significant research of IoT applications in healthcare and its evolution. Ibarra-Esquer et al. (2017) regarded IoT as being intelligent as well as an invisible network fabric that generate an embedded technology, which has the capacity of communicating either indirectly or directly via the internet. Internet of Things started to emerge in the 1990s but did not receive so much attention until early 2000. This is the time when the industry witnessed enterprise networks as well as consumer market demands. Notably, internet connectivity is said to have been low at the time due to insignificant performance linked to network connection. Ibarra-Esquer et al. (2017) assert that in the 2000s, Internet connectivity came out as a norm for most of the enterprise applications. This means that at this time, Internet connectivity became common across most of the enterprises thereby marking the genesis of IoT.
Chase (2013) noted that the world currently deploys around 5 billion smart connected things with forecasts attracting more than 50 billion connected devices before the year 2020. Chase (2013) indicates that the term IoT came in place in the year 1999 after Kelvin Ashton introduced it. While this looked impossible, the current technology trend reflects a significant growth of IoT after its implementation. Ibarra-Esquer et al. (2017) argues that implementation of IoT added a fresh way for the smart cities, emergencies, logistics, and security.
Kulkarni and Sathe (2014) believe that history of IoT, especially in healthcare, must have started around 1974 with the term described as an embedded computer system. At the time, this would incorporate a large system whose key function was never data processing. The systems in healthcare were implemented with the help of such devices like single board computers and microcontrollers among others. However, the devices have significantly gained momentum since the affordable use of the prototyping platforms such as Lego Mindstorms, Arduino and Raspberry Pi among others. It was until early 1990s where Mark Weiser thought of ubiquitous computing, which was later thought to be pervasive (Bhatt et al. 2017). The fundamental backbone behind ubiquitous computing entails the advances made by the embedded computing technologies as well as ubiquitous networks on a significant scale of several computers. Ibarra-Esquer et al. (2017) insisted that this concept closely resembled the actual IoT in which Weiser indicated the significant challenge of designing the operating system, which could host software that can exploit essential capabilities of networks. This informs on the background of IoT and how it made its way into numerous applications witnessed today.
Darwish et al. (2017) asserted that from the year 2012, IoT turned into an extension of the internet and the physical realm. This is remarkable extension is attached to smart objects as systems started bringing the user information in a secure way. According to Yuehong et al. (2016), the most important bit of the long history and evolution of IoT entail its application in healthcare. This has paved way for significant medical applications which include elderly care, chronic diseases, and remote health monitoring and fitness programs. The evolution of IoT healthcare services has attracted significant changes in healthcare in the 21st century, which counts as part of the IoT evolution since the dawn of the new millennium. Some of these services include the Ambient Assisted Living, which is a system that carries the potential of solving personal healthcare challenges.
The Ambient Assisted Living (AAL) systems are believed to facilitate an ecosystem of computers, wireless networks, medical sensors and software applications linked to healthcare monitoring. Perhaps, the study of AAL measures the ability of IoT in providing the ambient atmosphere for medical purposes. This can be linked to services provided by m-Health Things, which attract a new concept believed to match the functionalities of IoT and m-health. The two platforms are thought to define the new as well as innovative future linked to 4G health applications as linked to technological advancement and growth of IoT applications. Other services include adverse drug reaction, wearable device access, and semantic medical access, embedded gateway configuration and embedded context prediction among others. Baker et al. (2017) noted that IoT contributes to new types of healthcare opportunities. Based on this, most of the IoT systems have been directed towards diabetes management and rehabilitation through the AAL. In this system, for instance, designers would use pulse sensors, which are essential in reading vital sign upon detection of the wide range of the emergency conditions. Some of these conditions are not limited to vasovagal syncope, pulmonary embolism and cardiac arrest. Again, the respiratory rate sensors, which are known for respiratory conditions can trigger a system response. The study of AAL in the wide scope of medical applications is relevant to the study of Internet of Things and its relevance in the medical field. AAL weighs the apparatus that can be provided by IoT in fulfilling a medical goal, as it would be case of an automatic pill dispenser.
With more attention drawn towards IoT in healthcare and the smart pill dispenser prototype, studies are aligned to user centred design approach and its importance in the design process. According to Chammas et al. (2015), the user centred design is regarded as philosophy as well as a process, which puts a person at the significant centre while focusing on cognitive factors said to come in play during the people’s interactions. The user centred approach has attracted more attention over the recent years. A number of methods as well as tools felt necessary within organizations for the purpose of comprehending the user and task requirements. The user centred approach attracts the idea of electronic interfaces made possible through software engineering. Chammas et al. (2015) further noted that the interaction design, in which the design triggers users to incorporate the relevant product, can be a system or an app. While talking about the user centered design approach, most of the researchers would preferably talk of the interactive design which is known for handling problems while using available material.
The interactive design also finds more categories, which includes the genius design, activity centered design, and user centred design and system design. In the 1980s, Chammas et al. (2015) noted that most of the computer scientists and designers started the practice scope of designing systems, which used to be designed by engineers. However, in the subsequent years, software designers started a movement that concentrated more on the users than the computer. The movement could be referred to as the User-Centred Design (UCD), which is largely regarded as being based on ergonomics. The UCD approach attracts similar use of the procedure, the standard design guides as well as documenting for future projects. Notably, the ISO 14598 predecessors are known to have facilitated the significant translation of the UCD approach from complementary to significant software development methods. The approach is believed to be used across the system life cycle while explaining activities of the design and clarifying the user-centred design principles.
A significant number of principles are thought to be considered in the course of developing any interactive system. First, it is required that the project should essentially be based on the significant understanding of the users, tasks and the environments. The second principle entails users who need to be involved in the development process (Chammas et al. 2015). The user engagement, in this case, is regarded as a valuable resource attached to knowledge as far as the context of use and solutions are put into consideration. The third principle demands that the project need to be conducted as well as refined via assessments while focusing more on the users thereby minimizing risks of the system. Notably, the design needs to address the absolute user experience (Darshan and Anandakumar, 2015). The project team should also involve the multidisciplinary perspectives and skills. This means that team members need to emerge from separate areas with required views, experiences, and skills.
Leppänen et al. (2016) examine a discussion on the user centred design approach aligned to Internet of Things. The author stated that some efforts have been made to facilitate the coexistence and interactions between Internet of Things and human beings. The ecosystem avails human-to-things interactions with two key objectives. First, the ecosystem aids at improving the significant quality of the user experience as well as enhancing the collaboration. Human and things are expected to initiate bidirectional interactions in smart spaces. The realization of the interaction between Internet of things and use-centred design approach, as seen in the SandS project, indicates tools meant to personalize the significant behaviour of the smart things (Terninko, 2018). The process is relevant in the sense that it leads to better engagement, applications and sustainability due to the fact that applications and tools are built with authenticity of the user. Further observations can be made on the opportunistic IoT, which is known for making use of the human social behaviour as the mediator of communities with unconnected objects.
Leppänen et al. (2016) further denotes that the interaction between IoT and user-centred design approach is more evident in social IoT known for designing machines, which can communicate with other machines based on an autonomous social relationship. The social web of things is known for reusing the web architectures for the purposes of integrating most of the heterogeneous devices and the social networks (Dailychronicle24.com, 2019). Besides, the NFC and RFID are regarded as powerful technology enablers known for connecting the digital and the physical worlds. This can intuitively connect most of the smart objects with human beings (Baker et al. 2017). The study of human and things attracts significant observations on how technology interacts with people as noticed in the medical field. With increased discovery of smart objects, attention is given to the possible relationship people can have with smart things while pursuing health benefits.
Endsley (2016) believes that in designing the smart pill dispenser, it is necessary to have a user-centred design mind-set, which recognizes the essence of making use of applications and the design process. In this sense, Endsley (2016) seemingly asserts that the UCD approach, in the presence of IoT, prompts the designer to first focus on the customer’s needs. As it would be for the smart pill dispenser, the User Centered Design approach equally provides a common language for the stakeholders, designers as well as the end users. This is evident in the case of the Lunar Rover Mission carried out by NASA, which is said to have used the integrated user centred design. In addition, UCD approach attracts measurement as a significant part of the design process (Terninko 2018). This is because measurement creates a mechanism, which helps in understanding what is needed and what is to be improved. Apparently, the UCD approach would only attract simple sketches, which are simple to understand. A flow structure as well as navigation can highly support the main tasks. In addition, UCD approach is fundamental in attracting such technologies like IoT for the purposes of creating smart spaces.
Niting Bange, one of the team members, proposed a basic pill dispenser that helps the patients to take the medication on time, by notifying them through an alarm clock. The device was made of an Arduino controller, GSM model, 4x4 matrix model keypad, RTC module, LCD display and an alarm system. There are also significant limitations for this system and the most critical that need to be mentioned is that the system does not automate the pill dispenser mechanism and it does not keep record of the pills dosage (Cheung et al., 2015; Crema et al., 2015). In the first case of the pill dispensers, they had limitations such as the fact that is not automated. Sahil Upadhyay came up with a better version of a pill dispenser by making it automated. The automated pill dispenser is GSM based and has the purpose to assist the users with an age over 60, who tends to forget the periodical pill intakes.
The notifications that are generated based on the consumption of the pills are sent towards family members or carrier trough an SMS. The model uses GSM communication to provide interaction between machine and human. The limitation of the system is that it has issues with the network when communicating between modules. Andrea Mondrag'on proposed a better version of an automated pill dispenser. The device has the feature to attract the attention of the user when he/she misses the time to take the medicine. The system consists of 2 devices. One is the pill dispenser, which is a fixed device and the other one is a mobile device that can communicate with the fixed device in order to capture information and notify the user. The limitations of this system are that it does not provide evidence to monitor the pills intake and is limited in terms of portability and weight. Videet Parekh and Chris Pinto developed a pill dispenser device called "Avion", which uses a combination of an LCD display and a mobile application that remind elderly people to take the pills at the right time.
The device has different trays that allow to be filled with different tablet size. The limitations of the project are that the application cannot distinguish or know which pill the dispenser will provide for the user and the application cannot give a solution when the person forgets to take a pill (Mugisha et al., 2017; Kassem et al., 2019). Many researchers and scientists have brought improvements for the proposed IoT device but also, they face limitations and challenges. Maheswar Rao Kinthada proposed the latest system called "eMedicare" which has the purpose to act as a pill monitoring system. The device offers assistance for the patients with memory loss in addition to notifying the carrier if the pill is not consumed through messages or phone. The biggest limitation that faces such a system revolves around number of the pills that can be monitored at the same time (Billingsley, and Carruth, 2015; Kinthada et al., 2016).
Electronic healthcare technology is paramount and seems to have been spread across the world. The platform has increased the potential of enhancing clinical outcomes while transforming the care delivery. However, Coventry and Branley (2018) noted that healthcare has recently emerged as a prime target for cyberattacks. This is due to the fact that increased connectivity is equally increasing the exposure of medical devices, such as automatic pill dispenser, to cybersecurity vulnerabilities. Coventry and Branley (2018) denoted that cases of cybersecurity breaches constitute Ransomware attacks and stealing health information. The practices have largely crippled health systems, threatened human life as well as reduced patient trust. Why medical devices such as automatic are pill dispenser under attacks and faced by a series of security issues? Notably, the increased adoption of mobile consumer devices has made it difficult to protect the health data. Cases reported by media indicated that there is an imminent growth of attacks as well as medical identity theft in which millions of records have been lost. Notably, the rise in breaches has also been due to insider threats, malware and even hacking where medical devices such as the pill dispenser are considered as prime targets. Hacking and data breach essentially emerge from scenarios where there is erroneous security settings, sending unencrypted emails, malware attacks, losing medical devices and misuse of passwords among other cases.
Why do developers fall in the hands of hackers and cases of data breach? Khera (2017) noted that devices like the pill dispenser are becoming fond of Internet of Things among other technologies. IoT applications are growing at an unprecedented pace with forecasts pointing at almost 25 billion connected devices before the year 2020. Khera (2017) noted that security experts are becoming scared of the looming cyberattacks as far as IoT devices are concerned. History has it that criminals have increasingly breached the devices as they gain access to medical or personal information said to be stored in those devices. Developers are currently focusing on critical areas which include medical device vulnerabilities, IoT security hackers, application security and medical device security. Gawde et al. (2013) and Khera (2017) drew attention on vulnerable points and what makes the pill dispenser to be more vulnerable as far as hacking and cases of data breach are put into consideration.
Based on a case study conducted by Khera (2017), Billy Rios, one of the healthcare security researchers noted a series of vulnerabilities across drug infusion pump models believed to have been manufactured by Hospira. The model attracted infiltration of attackers who could remotely administer or issue fata drugs without leaving behind any trace. Another researcher, Mike Ahmadi, found almost 1400 cybersecurity vulnerabilities while making use of the CareFusion Pyxis SupplyStation. The scenario explains the common weaknesses a pill dispenser is likely to encounter as far as security threats are put into consideration. First are of concern includes the coding defects in which the firmware or software leaves loopholes for the attackers to easily create an erroneous situation. The case scenario of code defects is that of the buffer overflow vulnerability, which emerges when the underlying code gives room for the software to store more data in one of the temporary memory storages more than what they can hold (Gawde et al. 2017). A malicious attacker would therefore take advantage of the extra data in the buffers while instructing the system to perform new sets of commands in the system. Buffer overflow vulnerabilities are common to medical device software. Additional defects include the SQL injection vulnerability, which gives attackers an opportunity to introduce code snippets, which lead to system malfunction, cryptographic flaws and data leakages. This can happen in the presence of the broken cryptographic algorithms, cross site scripting (XSS) and non-procedural validation certificates which are likely to open up for scripts known to bypass the security controls.
Another common weakness that can happen to pill dispenser is the software design deficiencies, which occurs when there are cases of sloppy implementation of the authentication functionality and passwords. For instance, the use of MDLink software for automated devices can lead to storage of the password files in the hard drive. This means that any malicious entry would attract deletion of password profiles, and therefore attract cases of data breach and loss of records (Rathore et al. 2017). Weak passwords, for instance, have attracted cases of modified firmware and changed settings. According to the research conducted by Terry McCorckle and Rio noted that devices run by 40 vendors were afflicted with vulnerabilities. Among the devices were the patient monitors, drug diffusion pumps, anesthesia and surgical devices as well as external defibrillators. On the other hand, Fung et al. (2009) further indicates that security issues and threats on medical devices such as the pill dispenser emerge from network as well as misconfigurations.
Notably, devices running on outdated or old versions of operating systems with double whammy increase the vulnerability scale due to the foothold into networks which makes it easier for hackers to attack devices. In one of the reports released in the year 2015, researchers could determine a threat detection vendor known as TrapX, which is said to have targeted most of the windows-based medical app and devices. The same case would happen to automatic dispensing machines or devices which are connected to the general purpose device (Camara et al. 2015). TrapX would induce a virus into the network that corrupts files and records, thereby giving the hacker a leeway of inducing new information, which is not coherent to what the main system provides. As a result of the network misconfigurations, the WannaCry attack in 2017 led to infiltration of over 300000 devices as a result of the Bitcoin ransoms. Network misconfiguration and communication disconnections led to yet another attack known as the Medical Device Hijack, which is largely denoted as Medjack. The attack is said to have generated weak links within the hospital security defenses with the infection spreading to other devices (Pycroft and Aziz 2018). Similar attacks to devices further include brainjacking as well as white hacker simulated attacks, which are common to automated pill dispenser and machines as well as insulin pumps.
Based on the findings and previous developed projects, a table will be made to bring up the main issues that other developers had, which will help me to focus on the improvements over the new features that the Smart pill dispenses will have.
The survey led to the conclusion that there are devices that can meet some requirements, but also every improvement version leads towards a new limitation. The automated pill dispenser is a new advancement that needs improvement and offer simple features for the elder user with the purpose of making them understand how to use it. Also, the features must meet user's memory loss requirements in notifying them through voice alarms, or mobile app when the intake of the pill must be made or when is missed. Another important improvement is related with the intake of too many pills. Therefore, the device should contain a feature that doesn’t allow the user to overdose. The literature review went ahead to touch on the history of IoT, features of IoT that can be helpful in the design of the new dispenser as well as the significance of the user centred design approach. The UCD approach informs on the procedures and standard design guides, which can be relevant to the development process of the pill dispenser.
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