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`Europaisches Patentamt
`European Patent Office
`Office europeen des brevets
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`00 Publication number:
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`E U R O P E A N PATENT A P P L I C A T I O N
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`© Application number: 89304779.5
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`© int. CIA G06F 15/42
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`<§) Date of filing: 11.05.89
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`The title of the invention has been amended
`(Guidelines for Examination in the EPO, A- til,
`7.3).
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`Priority: 12.05.88 US 194018
`02.06.88 US 201779
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`Date of publication of application:
`23.11.89 Bulletin 89/47
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`Designated Contracting States:
`AT CH DE ES FR GB GR IT LI NL SE
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`Interactive patient assistance system.
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`© Applicant: HEALTH TECH SERVICES
`CORPORATION
`255 Revere Drive Suite 120
`Northbrook lllinois(US)
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`@ Inventor: Kaufman, Stephen B.
`1939 Lewis Avenue
`Highland Park Illinois 60035(US)
`Inventor: Hyland, Shelly
`4619 Daisy
`Crystal Lake Illinois 6001 2(US)
`Inventor: Lesczynski, Michael A.
`725 Shepard Road
`Gurnee Illinois 60013(US)
`Inventor: Bryant, Cai L.
`718 Morning Glory Lane
`Bartlett Illinois 60103(US)
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`© Representative: MacGregor, Gordon et al
`ERIC POTTER & CLARKSON 14 Oxford Street
`Nottingham, NG1 5BP(GB)
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`© A system is provided for interactively assisting a patient. The system includes a speech synthesizer and
`recognition unit coupled to a programmed computer. The computer can keep track of a medication and
`diagnostic testing schedule. The system also includes diagnostic testing equipment coupled to the computer
`along with medication dispensing equipment. In accordance with a predetermined schedule, the system verbally
`communicates with the patient, prompts the patient through the various steps necessary to carry out the
`diagnostic testing and further prompts patient at appropriate times for taking medication. The medication is also
`^ provided in combination with the verbal prompts. The system also provides access to a telecommunications link
`^in response to verbal requests of the patient and in one embodiment can move in a limited area adjacent the
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`MULTI-CONTAINER INTERACTIVE SYSTEM
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`Reference to Related Patent Application
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`The present patent application is a continuation-in-part of patent application Serial No. 194,018 filed
`May 12, 1988 entitled INDIVIDUAL ASSISTANCE SYSTEM and assigned to the same assignee as the
`present application.
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`Field of the Invention
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`The invention pertains to apparatus and devices for assisting individuals. More particularly, the invention
`pertains to a computer based system for providing at home or institutional assistance to a convalescing or
`injured patient.
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`75 Background of the Invention
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`Over the last several years, there has been a substantial shortening of the period of time patients
`remain in hospitals. Reductions in hospital stays are directly related to the Federal Medicare Regulations
`governing reimbursements to hospitals and other institutions. These regulations impose strict limits on the
`20 number of hospital days, or institution days, for which Medicare will reimburse the hospital or institution.
`Due to the shortened hospital stays, many patients are returning home in a debilitated or partially
`recovered condition. These patients often need assistance or reminders that medication should be taken, or
`that various measurements such as temperature or blood pressure should be made.
`This situation is exacerbated by the fact that the size of the population which is over 65 years of age is
`continually increasing and will be increasing for the foreseeable furture. In addition, because of the
`improved health care delivery system in general, patients with chronic diseases are surviving for longer
`periods of time and leading relatively normal lives with intermittent outpatient intervention.
`It has also been recognized that patients who need follow-up or who are convalescing at home can
`benefit from regular home monitoring. Such monitoring provides follow up information concerning the
`condition of the patient.
`For instance, home monitoring can provide information concerning the long-term effectiveness of drugs.
`This information can in turn lead to altering, increasing or decreasing prescription requirements to more
`cost effectively obtain the desired result with the patient.
`Home monitoring can also provide long-term trend information concerning patient vital signs. In extreme
`cases, home monitoring can result in immediate intervention to avoid a life threatening situation.
`Thus, there continues to be a need for devices and apparatus which would be of assistance to
`homebound patients in a variety of ways. Further, there continues to be a need for such devices which can
`be provided cost-effectively.
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`Summary of the Invention
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`In accordance with the invention, a patient assistance system is provided for repetitively interacting with
`an individual in need of assistance. The system can provide a variety of functions useful to an individual
`45 who may be debilitated or convalescing from an injury or an illness.
`The system includes a control unit which can provide a variety of patient support functions. A
`programmable clock/caiendar readout is coupled to the control unit. The clock/calendar unit can be
`programmed to perform reminder functions at predetermined times. For example, the clock/calendar unit
`can provide a wake-up alarm, can regulate medication dispensing, or can keep track of times at which tests
`should be carried out.
`An audible alarm or visual indicator can be provided as a reminder of when an activity should be
`commenced. The audible alarm can also be used to introduce an audible synthesized message.
`The system also includes voice synthesizer circuitry for the purpose of generating audible messages.
`The messages can remind the patient of specific, preprogrammed, tasks to be performed at predetermined
`times. For example, the voice synthesizer circuitry, in combination with the control unit, can remind the
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`patient that it is time to take medication or carry out a monitoring test such as taking a temperature or a
`blood pressure.
`The voice synthesizer circuitry can also be used to communicate with the patient when the preprogram-
`med schedule needs to be varied. That circuitry can also prompt verbal responses usable to determine
`general patient condition.
`Speech detection circuitry can be used to analyze those responses or requests. That circuitry can then
`signal the control unit with an identification of those responses.
`The voice recognition and synthesis circuitry can be used to verify, via audio feedback from the patient
`that certain tasks have been successfully performed. These include taking medication or conducting various
`tests.
`As an alternate, a keyboard could be used for operator input instead of voice recognition circuitry.
`Instead of a keyboard a touch-sensitive screen can be used.
`The system can also include sound and motion detecting systems. The sound detection system,
`coupled to the control unit, can detect ultrasonic transmissions from a patient transmitter such as a
`r5 medallion or a wrist transmitter. The sound detection system can also detect and enable the control system
`to respond to requests by the patient for assistance.
`A moveable embodiment of the system includes an ultrasonic collision avoidance system. The
`ultrasonic system can determine distance, range and proximity of objects for collision avoidance purposes.
`Further, the ultrasonic system enables the patient assistance system to move within a specified region near
`the patient to provide for easy accessibility thereto.
`The system can also include an interface between the control unit and a telephone. In response to
`commands from the control unit, the interface can provide for automatic dialing in response to patient
`requests or in response to detected emergency conditions.
`The system also includes a printer for generating a hard copy record of daily medical information
`including test results as well as delivery of medication. A recording system can store that information in
`machine readable form.
`A modem is coupled to the automatic dialer in the interface. The modem can be used for the purpose
`of communicating with a remote medical computer, for transferring patient information to the remote
`computer or for receiving programmed instructions or information from the remote computer.
`Further in accordance with the invention, a method of interacting with a care requiring individual is
`provided. The method includes the steps of:
`detecting audio emergency requests for help from the individual;
`detecting when the individual should receive predetermined medication;
`making the predetermined medications available to the individual in accordance with a predetermined
`schedule;
`verifying that the predetermined medications have been received by the individual;
`recording electronically the fact that the medications have been provided as well as the fact that an indicium
`has been received that the medications were received by the individual;
`reminding the individual to carry out certain predetermined monitoring tests at predetermined time intervals;
`recording electronically results of the predetermined tests;
`automatically dialing a predetermined number to establish a communication link with a remote information
`receiving unit; and
`transferring the results of the monitoring test step to the remote unit.
`Numerous other advantages and features of the present invention will become readily apparent from the
`following detailed description of the invention and the embodiments thereof, from the claims and from the
`accompanying drawings in which the details of the invention are fully and completely disclosed as a part of
`this specification.
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`so Brief Description of the Drawings
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`Figure 1 is a perspective view of a stationary recordkeeping and medication delivery interactive
`system in accordance with the present invention;
`Figure 2 is a perspective view of a moveable recordkeeping and medication delivery interactive
`system in accordance with the present invention;
`Figure 3 is a block diagram schematic of an electronic system in accordance with the present
`invention.
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`Figure 4 is an overall perspective view of a system in accordance with the present invention
`interacting with a patient;
`Figure 5 is a fragmentary perspective view of the system of Figure 4 supported on a powered
`module for movement;
`Figure 6 is a rear elevational view of the system of Figure 4;
`Figure 7 is an enlarged fragmentary view in perspective of a portion of the thermometer
`storage/delivery unit;
`Figure 8 is an enlarged fragmentary view in perspective of a portion of the product storage/delivery
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`Figure 9 is an enlarged fragmentary view in perspective, partly broken away, of the actuating
`mechanism of the storage/delivery unit of Figure 7;
`Figure 10a is a view in section illustrating a first or inactive state of the product dispensing
`mechanism;
`Figure 10b is a view in section of the product dispensing mechanism in a second or dispensing state;
`Figures 11a-11e, taken together, are a flow diagram of the software and interactions of the system of
`Figure 4;
`Figure 12 is an overall block diagram schematic of the electronic control system of the system of
`Figure 4;
`Figure 13 is a detailed electronic schematic of a portion of the interface circuitry of the system of
`20 Figure 4; and
`Figures 14a and 14b, taken together, are a detailed electronic schematic of another portion of the
`interface circuitry of the system of Figure 4.
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`25 Detailed Description of the Preferred Embodiments
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`While this invention is susceptible of embodiment in many different forms, there are shown in the
`drawing and will be described herein in detail specific embodiments thereof with the understanding that the
`present disclosure is to be considered as an exemplification of the principles of the invention and is not
`intended to limit the invention to the specific embodiments illustrated.
`Figure 1 is a perspective view of a patient assisting system 10 in accordance with the present invention.
`The system 10 includes a housing 12. carried by the housing 12 is a video display unit 14.
`The system 10 includes a clock/calendar unit 16. The clock/calendar unit 16 can be a digital unit with
`an integrally formed display.
`The housing 12 carries an audible alarm 16a. The audible alarm 16a can be actuated by the electronic
`clock/calendar unit 16. The clock/calendar unit can be a programmable unit in which a schedule can be
`established to identify a variety of scheduled activities during a 24-hour interval. A display 16b is also
`coupled to the clock/calendar unit 16.
`The housing 12 also carries a hard copy printer 18 capable of generating hard copy 20. The copy 20
`40 can include information pertaining to medication schedules, delivered medication, test results or instructions
`as may be desired.
`The system 10 can also include a blood pressure monitoring cuff storeable in a region 24 of the system
`10. The same cuff can be used for pulse rate detection as well.
`The system 1 0 can also include a thermometer 28 coupled thereto. The thermometer 28 can be drawn
`from the system 10 and used by the patient to provide an indication of corporal body temperature. The
`thermometer 28, the blood pressure cuff and the pulse rate sensor can be used to provide feedback to the
`system 10 concerning patient related characteristics. Temperature and blood pressure measurement values
`can be displayed using readouts 29.
`The system 10 also includes a pharmaceutical dispenser 30. The pharmaceutical dispenser 30 can
`so under control of the system 10 dispense medication on a strip 32 in accordance with a schedule maintained
`by the programmable clock/calendar unit 1 6.
`The medication on the strip 32 can be dispensed in combination with either a printed reminder which
`can be printed by the printer 18 on the strip 20 or in combination with a verbal reminder. A voice
`synthesizer and recognition unit 36 carried by the housing 12 can provide audio reminders to the patient
`that a scheduled time for taking a medication has arrived. The unit 36 can provide audible feedback from
`the patient to the syste 1 0.
`For example, the voice synthesizer and recognition unit 36 can detect statements made by the patient
`requesting assistance. These statements can include requests for help if the patient is in need of outside
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`assistance. Alternately, the voice synthesizer and recognition unit 36 can detect requests by the patient to
`display information on the display 14 or to provide the appropriate medication. Finally, the voice synthesizer
`and recognition unit 36 can be used by the patient to establish the schedule to be maintained by the
`programmable clock/calendar unit 16.
`It will be understood that in addition to detecting blood pressure, heart rate and body temperature, the
`system 10 could provide facilities for detecting blood gas levels as well as carrying out other types of non-
`invasive diagnostic tests. For example, one type of diagnostic testing that can be carried out in connection
`with the system 10 make use of known oximetry probes. Such probes can be attached to the ear lobe or
`finger of the patient and provide for continuous or intermittant reading of oxygen saturation levels in the
`10 blood.
`The system 10 also incorporates a modem 40 which can be utilized in combination with an automatic
`dialer unit 42. The modem 40 could incorporate a standard type of telephone handset 44 if desired. By
`incorporating a handset 44, the system 10 can provide for a voice communication between the patient and
`a remote location.
`By means of the modem 40, the system 10 can communicate with a remote medical center over the
`telephone system. Information which has been accummuiated in the system 10 concerning patient activity
`or the results of diagnostic testing can be automatically transmitted via the modem 40 and the telephone
`system to a remote medical center computer for analysis. The results of such analysis can be used to
`determine whether or not further intervention, such as changing the medication schedule or the type of
`20 medication, is desirable.
`The system 10 can also include a magnetic recording system. The recording system can record, on a
`relatively long-term basis, results of diagnostic tests, information concerning patient activity, dispensed
`medication and any other information of value in improving the quality of patient care.
`The various elements of the system 10 function with a control unit 46. The control unit 46 could include
`a programmed computer.
`Figure 2 illustrates a perspective view of an alternate embodiment 50 of the system 10. The system 50
`includes many of the functions and capabilities previously described with respect to the system 10. Such
`elements are identified using the same identification numerals as were used with respect to the system 1 0.
`In addition, the system 50 provides additional capabilities and functions not present in the system 10.
`30 The system 50 in contradistinction to the system 10 is moveable under the command of the internal
`programmed control computer 46. The moveability of system 50 permits it to move toward the bedside or
`chair of the patient for ease of interaction with the patient.
`Control over the movement of the system 50 by the computer 46 is effected by an ultrasonic system
`52. The ultrasonic system 52 includes both a transmitter and a receiver 52a and 52b respectively. The
`35 ultrasonic system 52 can detect transmission from a patient-carried transmitter. The patient-carried
`transmitter can be used to inform the system 50 of the location of the patient. It can also be used to detect
`whether or not the patient is ambulatory and whether or not the patient has had an accident and has fallen
`and is in need of additional assistance.
`The ultrasonic system 52 can also determine distance, range and proximity to objects for the purpose
`40 of collision avoidance. The ultrasonic system 52 also permits the patient assisting system 50 to safely move
`within a specified range near the patient.
`The system 50 also includes a nasal cannula 54 usable in connection with administering oxygen
`therapy. Further, the system 50 can also include a probe 56 for measuring saturated oxygen levels in the
`blood, as previously discussed. Such probes, such as 56, are noninvasive and can readily be affixed by the
`45 patient to the appropriate corporal member.
`The system 50 also includes a digital blood pressure sensing cuff 60 which can be removed from the
`storage region 24. The patient can apply the cuff 60 to an arm or finger or any other appendage. Under
`control of the system 50, the cuff 60 can be automatically inflated, the results of the blood pressure
`measurement can be detected by means of the monitoring function input interface 48. The cuff 60 can then
`so be deflated and removed by the patient for storage in the region 24.
`Simultaneously with detecting blood pressure by means of the cuff 60, the patient's pulse rate can also
`be detected.
`The system 50 includes the voice synthesis and recognition unit 36 which provides an audio
`communication and control path between the patient and the system 50. A battery 64 is carried within the
`55 housing 50a for the purpose of powering the unit 50. The battery 64 can be a rechargeable type which can
`be recharged during periods of patient inactivity, such as night.
`If desired, the handset 44 can be of the cordless type. In this instance, the system 50 would also carry
`a transmission/reception antenna 66.
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`It will be understood that the system 50 functions at all times under the control of the programmable
`unit 46 to insure proper carrying out of the above described functions. Further, by means of the voice
`synthesis and recognition unit 36 the patient is always able to provide verbal commands to the unit 50.
`Further in accordance with the invention, Figure 4 illustrates as an alternate embodiment, a system 100
`in accordance with the principles of the present invention. The system 100 is being utilized by a patient P
`for purposes of carrying out a diagnostic test. Many of the elements of the system 100 correspond to
`elements of the system 10 and the system 50. Corresponding elements have been identified with the same
`identification numerals as were used in Figures 1 and 2.
`The system 100 includes a housing 102. The housing 102, at an upper surface 102a, can support an
`10 optional display unit 14, indicated in phantom. The housing 102 also carries an alphanumeric display 104.
`The alphanumeric display 104 can be used to conveniently display the results of various diagnostic tests
`which can be performed by the system 1 00.
`In particular, the system 100 is illustrated in Figure 4 with the patient P using a finger type blood
`pressure and pulse rate cuff 106. The cuff 106 can be used to detect the blood pressure and pulse rate of
`the patient P.
`Supported on an upper surface 108 of the housing 102 is a telephone corresponding to the telephone
`44. It will be understood that a variety of different telephones can be used without departing from the spirit
`and scope of the present invention.
`Also carried on the surface 108 is a loudspeaker 110 which is coupled to the voice synthesis and
`recognition unit 36 discussed previously. A hands-free microphone 112 is also provided, coupled to the
`voice synthesis and recognition unit 36, for purposes of audio input by the patient P.
`The housing 102 also supports a plurality of visual indicators 120a, 120b and 120c. The indicators 120a,
`120b and 120c are usable in conjunction with a plurality of moveable storage/delivery units 124a, 124b and
`124c.
`The storage/delivery units 124a, 124b and 124c can be used for storage and delivery of a plurality of
`different items. For example, the unit 124a is illustrated in the system 100 as being the storage/delivery unit
`for the finger type cuff 106. The indicator 120a is utilized to prompt the patient P to the fact that the unit
`124a has been released and the cuff 106 should be removed therefrom and inserted on the patient's finger
`for purposes of conducting a diagnostic test.
`The unit 124b can be used for storage and delivery of a thermometer. The unit 124c can be used for
`storage and delivery of prescheduled products. The products can include medications in either liquid or
`solid form.
`It will be understood that the types of apparatus and/or products, described above, utilized with the
`units 124a, 124b and 124c are merely exemplary. The exact type of apparatus stored or product delivered
`is not a limitation of the present invention.
`The housing 102 also carries a manually operable, illuminatable signaling button or switch 126. The
`button or switch 126 can be used by the patient P to inform the system 100 that various activities have
`taken place or that various conditions have been met.
`For example, the button or switch 126 can be used to prompt the system 100 to the fact that the patient
`40 has placed the cuff 106 on a finger and is ready for a blood pressure measurement to be made. Similarly,
`the switch 126 can be used to prompt the system 100 to the fact that the thermometer has been properly
`positioned and a temperature reading can be made. Finally, the button or switch 126 can be used to prompt
`the system 100 to the fact that a product, such as a medication, has been removed from the unit 126 and
`has been taken by the patient P.
`While the system 100 has been illustrated in Figure 4, supported on a plurality of rollable casters 130, it
`will be understood that, in accordance with the embodiment previously discussed in Figure 2, the system
`100 could be provided with a motorized unit for purposes of movement.
`Figure 5 illustrates an exemplary motorized unit 132. The unit 132 carries the housing 102. The unit 132
`includes a motor, control electronics and power source 134. The unit 134 can be mechanically coupled to
`so drive wheels 136 for the purpose of moving the system 100 toward or away from the patient P.
`Figure 6 is a view of the rear of the housing 102 illustrating various components of the system 100. The
`housing 102 defines an interior region 140 wherein the components of the system 100 are carried.
`The system 100, as discussed previously with respect to Figures 1 and 2 includes a programmable
`control computer 46. The computer 46 can be of a type comparable to IBMR-PC-XT or other computer
`system capable of performing multi-tasking. The unit 46 can include an interface for driving the display 14,
`if present, by the system 100. The unit 46 can also include the programmable clock/calendar unit 16.
`The unit 46 can also include a disc drive controller.
`Disc storage 142 can be located within the housing 102 adjacent the computer 46. The disc storage
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`142 can include a hard drive and one or more floppy drives depending on the desired capacity of data
`storage.
`The computer 46 can also include the modem 40. The modem 40 could be for example a 1200 baud
`Hayes brand modem.
`Adjacent the disc storage 142 is a system power supply 144. The supply 144 can include a
`rechargeable battery.
`The voice synthesis/recognition unit 36 is also located adjacent the control computer 46. The voice
`synthesis/recognition unit 36 could be for example, a Texas Instruments Recognition and Speech Unit
`Model TI-22451 86-001.
`An interface card 146 is also provided adjacent the control computer 46. The interface card 146
`provides part of the circuitry used for driving solenoids to control the units 124a, 124b or 124c as well as
`the displays 120a, 120b and 120c. For example, the unit 146 could be a Quatech Analogue input card or
`equivalent as would be known by those of skill in the art.
`The housing 102 also carries electrical interface circuitry 148. The circuitry 148 converts signals from
`the measurement cuff 106 to electrical signals usable by the monitoring function unit 48.
`The housing 102 also carries the printer 18 for a generation of hard copy records 20 or graphical
`diagrams.
`Figure 7 is a perspective, fragmentary, view illustrating the storage/delivery unit 124b in the delivery
`position. In the exemplary unit illustrated in Figure 7, the unit 124b is a multi-sided drawer with a bottem
`20 150a joined by four sides 150b, 150c, 150d and 150e.
`It will be understood that the exact shape of the storage/delivery unit 124b is not a limitation of the
`present invention. A variety of different shapes could be used which would function in substantially the
`same way to produce substantially the same results.
`Carried within the unit 124b is a thermometer 152. The thermometer 152 is coupled by conductors 154
`to the monitoring function interface unit 48.
`As illustrated in Figure 7, the indicator 120b has been energized indicating to the patient P that the
`system 100 is awaiting the withdrawal of the thermometer 152 from the unit 124b and the subsequent
`actuation by the patient of the control button 126.
`As illustrated in Figure 4, the unit 124b has a first, or closed, position. The unit 124b also has a second,
`30 or open, position as illustrated in Figure 7. Each of the units 124a and 124c has corresponding first and
`second positions.
`Figure 8 illustrates the unit 124c in its second, or open, position. The indicator 120c has been energized
`indicating to the patient P that a product such as medication M in unit 124c is available and can be
`accessed in the drawer 124c. It will be understood that while medication M has been illustrated in solid, or
`35 pill form, in Figure 8 that the exact form of the dispensed product is not a limitation of the present. The
`product need not be a medication or alternately could be in liquid form.
`Figure 9 is a fragmentary enlarged view of the unit 124b along with an associated electrically operated
`release mechanism 160. The release mechanism 160 could be an