No app required: The NB-IoT pill dispenser changing medication management in care homes

Daniel: So wirewire is a pretty young company. We are just three engineers in our team. I am the hardware engineer and we also have Robert and Chris. I think we'll introduce them later. We build basically IoT devices. The wide range of IoT devices is what we want to build, and the pill dispenser is one of our first projects. Obviously we began with something really big. We sometimes think about if this was the right decision, but now it's done. Now it's fine. Now it's a good product. And yeah, this is our business. We want to make daily devices, like devices you use daily. We want to make them smart. We want to connect them.

Ruth: Okay. Before we dive into the hardware part of it, let's talk about the problem. People not taking their pills is a well-known issue in healthcare, but what does that actually look like in a nursing home setting?

Daniel: Of course the baseline of our idea is how successfully people take their medications. And there are numbers like around 50% of the medication is not taken in time. Of course, this has a wide range of parameters, but obviously there's a big issue in reliably taking medications. So we focused on this issue and we tried to solve it with this box that reminds the patient or the user to take the medicine and also observes if the medicine is taken in time.

Ruth: 50% is really a lot.

Daniel: Yes. This is also something that costs a lot of money to the caregivers, to the health system in Germany. I don't know the exact numbers, but of course it's millions of euros that are lost, or that are racking up, because the people need to get extra treatments or they get new issues because they don't take the medicine.

Ruth: So a little pill box that is not really that glamorous makes a big difference in a healthcare system. So walk me through the ANABOX smart. What does it do and what does it look like in practice?

Daniel: So the ANABOX smart — if you need to imagine it — it's the size of an A4 sheet of paper, like a normal sheet of paper you put in your printer. And it has 27 compartments, so seven days by four intake times, which is the baseline for most people. So they have like in the morning, at lunchtime, in the afternoon, and maybe also at night. And in every compartment you put your medicine. In parallel, you also provide information to the box via app — or the caregiver provides information via app — which dose needs to be taken when. The box automatically synchronises with the app, places an alarm if a dose is scheduled, and also tracks if the compartment is taken out in time, and reports all this data back to the app so the caregiver can observe this information.

Ruth: And you use NB-IoT and LTE-M, and there's an industrial SIM card built into the device as well. Why did you choose this technology?

Daniel: When we started the project, like five, seven years ago, this technology was quite new still. Of course it's a big standard, but still kind of unknown to the normal user. The big advantage is we can have a built-in data connection, which is useful for the target group because elderly people often don't have the infrastructure — they don't have a Wi-Fi router, they don't have internet connections. Of course this may change over time, but right now this is still in fact how it is. And the IoT connection makes the box always available. So you just scan the QR code on the back of the box with the app and it connects once. And from this point you can put the box wherever you want, and you can also access the information from the box wherever you want.

Ruth: Interesting. And I can imagine that for this target group the hurdle is not as steep. You do not have to configure anything. You do not have to switch settings in your smartphone or connect to different infrastructure types, as you have mentioned. So I imagine that for an elderly target group that also makes it quite easy to use.

Daniel: Yes, exactly. And our idea is the patient or the person having the box is not really connected or in contact with the app. The box itself looks like a pretty standard medicine dispenser — a plastic box with big compartments that are also easy to grip with your fingers. And the only thing that is different is that there's a light under the compartment and that it has a built-in alarm. The app itself is with the caregiver or the person responsible for the observations. So the patient does not need to have any contact with the app. Yeah, we want to make it as easy as possible for the target group.

Ruth: Okay. Yeah, that is something that struck me in our briefing — the patient does not have access to the app, only the carer does. And as you have just mentioned, that is a deliberate design choice. Walk me through that logic. Can you provide some more background on this?

Daniel: The patient can of course have access to the app if they want. We also have some people who just use it — I would call it more of a lifestyle product. They use it for their vitamin pills and things like this. Of course you can use it, and then you're probably young enough to also understand the smartphone infrastructure. But usually the people don't. We find that elderly people don't like this fancy technology too much, obviously. They want to have it simple. And this is the idea. So the box itself looks pretty analogue. It's pretty decoupled from all the rest of the infrastructure. Looks like a normal pill dispenser. And the app itself gives a lot of options. So you can make it simpler and just set an alarm for each compartment, but you can also manage your medication plan — you can assign each medication to each day, you can add multiple users, which is obviously useful in a professional environment. You can also add multiple boxes, patients, and so on. So this is really a more complex topic for professional use.

Ruth: Okay. And from the patient's side, what happens when it's medication time? What do they see and what do they hear?

Daniel: This is kind of dependent on your setup, but the baseline is you get a decent alarm — like a kind of silent reminder — and also a silent beeping from the box. And the compartment itself, as one of the 27 containers, will begin to blink. So you see exactly which compartment you need to take out. And once you have taken it, the light stops and the alarm — in case you configure a more intense one — will also stop.

Ruth: Going back to the technology — NB-IoT in particular. What does it give you that other protocols simply cannot? Is it purely about connectivity in environments where Wi-Fi is unreliable, or is there more to it?

Daniel: NB-IoT is designed to connect products with less data usage. So this is the big difference from normal LTE smartphone devices. The advantage for us is mostly the cost, because we don't need big data packets. We use roundabout 100 megabytes of data per year with the box — maybe even less, depending on the usage. This gives us good options on contracts that are not available with standard SIM cards that cost 30 euros per month or 20 euros per month. And ours is much cheaper. So we have the option to connect the box and we don't need the customer to pay extra fees each month.

Ruth: Okay. And you already mentioned some use cases — maybe younger customers use it as a lifestyle product, but also elderly people who need help being reminded of their medication use it in a nursing home setting. And I think you have already deployed the solution into some nursing homes. What does the roll-out look like in practice? How does the box slot into an existing care routine, or does it change the routine for the people who take care of their patients?

Daniel: We have already discovered that some environments are really good for the box, others are not. For example, hospitals are difficult for us because the patients need an observed intake each day. This is difficult with the box because they are not allowed to pre-fill multiple medications for the patient. But what works well is the home care environment. So if, for example, a care person comes every day and brings medication, we can maybe reduce this effort to once every week. This already saves a lot of time — just once every week the care person needs to refill the box. And at the same time, someone can observe if the intake happens. And as a side effect for other people, or like the closer family of the patient, they really see that some interaction happens. So they see the person is still doing something. I know it sounds odd, but it's quite helpful in some situations. I know from a friend — he had his grandmother who was alone at home, and she fell, and they only discovered her a day later. And of course this is a difficult situation that is obviously not new for us. We know that this happens a lot. And this box can give you a bit more insight — to see and to act if there are some difficulties.

Ruth: Okay. So it actually can also help in emergencies — like an alarm signal, probably. Like when there is no reaction, you know that something is wrong at home.

Daniel: At least it's some extra information you get that you usually may not have. The best situation is of course you have a good relationship with your elderly relatives and you call them at least once every day. I don't want to judge, but we all know that reality is often different. We all have things to do and maybe we forget, and often the bad stuff happens in this situation. So you have one more piece of information available that can kind of check if the people are well and if everything kind of works.

Ruth: Yeah. Maybe we can also reframe it positively. I didn't want to sound too harsh there. But you can also, of course, with a solution like this, stay at home in your own environment for a longer period of time. If there is someone who kind of keeps an eye on you and makes sure, first of all, you take your medication, and second of all knows when something goes wrong — you don't necessarily have to go to a nursing home right away. You can still live your own life for a longer period of time.

Daniel: I think what you described is the core message of all those products that want to make this period longer — where people can stay at home and not need to enter new, observed environments. We all want to stay at home as long as possible. We like our familiar environment. And I think this box can really help to make that period longer.

Ruth: And then of course there is a cost argument here as well. Nursing care is expensive. So how does the ANABOX smart translate into actual savings, and for whom — I assume the home, the insurer, and the patient?

Daniel: What we do now is we have already registered the box successfully as a care product, so it's listed and can be prescribed to patients. And of course the cost system wants to see benefits from products. They want to save money, obviously, because we are very expensive. And also, as you described, administering those medicines each day is very expensive. And if we can save costs in this field without disadvantaging the patient, I think it's perfect — because then it's like a win-win situation. The patient is more independent and the care system can save some money and can use it to address other challenges.

Ruth: We will take a short break. Stay with us and we will be hearing from our guest very shortly. This podcast is brought to you by Avnet Silica, the Engineers of Evolution. Subscribe to our Avnet Silica newsletter or connect with us on LinkedIn. If you want to learn more about us, we have put information and links in this episode's show notes.

Ruth: Getting a medical device to market in Europe is not simple. But you now have a pharmacy approval, if I understand it correctly, and a Class I classification under the EU MDR regulations. What did that journey look like?

Daniel: Class I is obviously easier than the higher classes used in hospitals, which need to fulfil much more regulation. But anyway, it's a medical product, which is often required also for prescriptions. And the journey was long and intense. It's a lot of bureaucracy, a lot of documentation, a lot of requirements, and a lot of parties involved in the regulatory process. We are hardware developers. Our partner is already in the market and sells medical products, which was helpful. But anyway, it was a lot of new stuff for us because it's an electronic product and this we had never done before. We had to learn how to document, how to test, which certifications it needs. And it was a long journey. Definitely.

Ruth: You also have commitments from two health insurers to include the ANABOX smart in their catalogue. How did you get there, and what does "in the catalogue" actually mean for a manufacturer?

Daniel: What we have now is the listing in the care product catalogue. Which means generally it is possible to get money from your health insurance for it. We have a very diffuse system in Germany with a lot of parties involved in the health system, which makes it very complex. But it basically means the parties can give you money — or even pay for the entire box for you. But we are still in the process of figuring out what's best to make this possible. So we go together with patients to their health insurance and we try to negotiate how the cost approval works, and how to make the flow as easy as possible.

Ruth: The device is designed to work across Europe, not just in Germany. You have European patents and an industrial SIM card with EU-wide coverage. How important is that pan-European angle?

Daniel: It's an opportunity, definitely. Honestly, we have customers around Europe, but it's not our main market for this product right now. We want to improve. For example, Switzerland is a good opportunity, and also Austria — we have some customers, so more the nearby ones. Technically the product is ready for this, so we can roll out in other countries. If we sell it as a normal product with a price tag, that's also fine. If we want to also make it possible with other health systems, of course that's more work. I don't have a schedule for when we can do this, but maybe this is also an opportunity for the future. Definitely.

Ruth: And I think you mentioned that with the industrial SIM card you can also take the box on holiday, for example. I think that also helps with that.

Daniel: Yeah, technically it's possible. The SIM card is pretty widely available in Europe. There are some countries that are not supported, but most of them are. And yeah, you can technically take the box with you. Of course it's not that small, but we really do have people who do this. They take the box with them and use it in different places, which is also a nice feature.

Ruth: Your core message, if I understand it correctly, is about taking classic business models and digitalising them using unobtrusive, familiar objects. The ANABOX is a pill box, and you also work with e-paper and digital photo frames. Is there a common thread?

Daniel: Yeah, exactly as you describe it. We want to take analogue products and make them smart, and integrate them into a technology ecosystem. So our other product is very different from this medical product. It's a pure lifestyle product — it's an e-paper photo frame. Which means you have a picture frame that at first glance looks like a normal picture frame. Most people cannot tell if it's an electronic product or not. But you can update this picture frame also via app. What most people know is the Amazon Kindle readers — that black and white e-paper. But technology is evolving and we now have colourful e-paper, which makes it possible to show real pictures on e-paper. And they look literally like print. It's not what you know from your smartphone screen, it's not what you know from your computer screen. It's really something different — it's not glowing. And this literally looks like paper.

Ruth: Wow, interesting. You are a startup. What has gone well for you so far, and what has maybe not gone so well since you started building this?

Daniel: Definitely we are still a startup. Yes, we are small, we are developing fast, which is good. We did a lot of things right because the ANABOX smart worked. It's a very complex product and we managed somehow to bring it to market, which is also a good feeling — to have your own product that you developed yourself, and now people are using it and are really happy using it. This is a fantastic feeling. If I had to decide again some years back, I would not start with the ANABOX smart, because it was a very complex and long-lasting project. I would probably go with a more straightforward project like this e-paper frame first. But it doesn't matter now. We have both products and they both work quite well. And I can just recommend to people to check the markets, to always talk to the people. Don't just develop by yourself. Try to always involve all the parties you develop for. We also made this mistake in the beginning. We made the box way too small and we talked to the people using it and they said, no, we cannot get the compartments out of the box. So we needed to make a complete redesign. If we hadn't done this, we would have a product now that's not fitting the market, and in the end that's a waste of money.

Ruth: What comes next for wirewire and the ANABOX smart? Where does this go in the next two or three years?

Daniel: We hope we can do more with the caregivers, with the health system, and we hope we can give more access to the box to patients and to users generally. Right now you can just buy the box on our website. For the future, we want to have it as a real health product that you can discuss with your doctor, and then get it as a genuine prescription. And we want to give more support for companies and environments that take care of people.

Ruth: You work together with a medical company on this product — I think they're called Anmed. You work with a partner. Do you want to elaborate a little bit about this partnership?

Daniel: Yeah, exactly. We began to work with Anmed. This is a company based in Berg, Germany, and we came to them with our idea and luckily they liked it. So we started a kind of partnership with them, and they were always a big help for us because they are already a bigger company. They already built pill dispensers — you know, the normal plastic boxes you can buy at the pharmacy. And they were always helping us with the processes, and they also help us with the injection moulding. And I think without this partnership the product would not have been possible for us, because it's just way too complex, way too expensive.

Ruth: And you already mentioned some suggestions you would have for other hardware developers who want to build IoT products — to always work with a partner, understand the market, understand the user and their needs. Is there anything you would like to add to that?

Daniel: For me as a hardware developer, it's a great time now because a lot of things are changing. This rapid development is getting real. We can literally order hardware and get it in the next 10, 15 business days, which was so expensive and so complex in the past. So everybody can do it. Everybody can start developing hardware right now. We also have a low entry level because there are a lot of communities where you can learn what hardware development means and how to develop products. But in the end, finishing a product is way more complicated than most people think. Having a prototype that works is, in my opinion, the first 10%. And the other 90% is getting the product to market — which is documentation, finding partners, getting supply chains, meeting requirements, and all those things. It's not like I want to scare someone. It's part of the process. But you should keep this in mind when you think about how much a product should cost. It's not the end of the journey when you have a prototype that works. You need to really find a process that works long term.

Ruth: And it's probably also part of the fun to figure all this stuff out.

Daniel: Definitely. Definitely. As a hardware developer, you need to be ready to suffer a little bit. I think this is something those kinds of people — like in my opinion, that's why it's maybe not for everybody. I can also say we got a lot of support from Avnet. They were with us from the beginning. They gave us support selecting the right parts, and we are still in very close contact with them. I would even say that some of the employees are now kind of good friends. We really talk with each other about what we do, and it's not always about business. So this also helped us a lot with the electronics to get to the point where we are now.

Ruth: Terrific. If you had to put together a soundtrack for this episode, what song would you put on it?

Daniel: Red Hot Chili Peppers, Californication. This is a great song and I love their music and I love rock music. And this is like a good song to start with in summer now, I think.

Ruth: Okay, terrific. Thank you so much, Daniel, for joining us and sharing your expertise. The ANABOX smart is a reminder that some of the most meaningful IoT applications do not have to be super glamorous — they are taking a classic business model to the next level and helping many people live a longer and more independent life. So that is terrific. Thank you so much for being on the show.

Daniel: Thank you. It was a great time.

Ruth: Thank you for listening to We Talk IoT. Stay curious and keep innovating.

Ruth: This was Avnet Silica's We Talk IoT. If you enjoyed this episode, please subscribe and leave a rating. Talk to you soon.