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ALTHA INTRODUCTION

Welcome to AlthaRx, a cloud-controlled medication dispensing system. The Altha dispenser is designed to enable a patient to access their medications wherever they are living using a tamper-resistant dispenser that facilitates real-time remote support and real-time medication monitoring. You as the pharmacist, can allow any number of caregivers or family members (referred to as personal caregivers) to monitor and remind the patient to take their medications. These notifications can be customized for each personal caregiver as requested.

You can assign, setup and monitor the Altha dispenser through a browser interface (see "Notifications") and can guide the patient to associate their dispenser with their fingerprint (since the dispenser is biometrically-controlled).

Once you initially set up the dispenser, it will continue to operate without further configuration until you need to modify the dosing regimen or reminder alerts for the patient or their personal caregivers.

Account Activation

ACCOUNT ACTIVATION

The first step for you before you can use the Altha system is to connect into the Altha server via your web browser, using the link provided in the AlthaRx welcome email message. This message can be found in the inbox of the email account provided to the AlthaRx team. If the email is not found in the inbox, then please check the junk or spam folder.

If this is the first time you are logging in, you will have to first enter the username listed on the signup form and carefully enter the temporary password provided to you in the email or text message.

During your first login, you must activate your account by selecting a personalized password. To do this, follow the instructions on the screen and enter a new permanent password that meets the parameters shown in the image below and select "Activate".

After you login you can bookmark the site for easy access in the future. If enabled, your web browser will remember the username and password for the site, which will make subsequent logins fast and easy.

Examples of the onboarding messages that are received as emails and text messages can be found in the troubleshooting section.

THE DISPENSER

As shown, the dispenser has a large touch screen enabled LCD display, two buttons (one to adjust the brightness on the LCD display and the other to adjust the sound for alerts) and a fingerprint reader. There is also a medication dispenser tray at the bottom of the dispenser with a closing flap to help prevent medications from falling out once they are dispensed.

The dispenser has a carrying handle which also serves as a stand for the dispenser. Once the dispenser is placed on a steady surface where it is to be used, the carrying handle should be pulled at both ends and rotated so that the bottom of the handle can sit flat on the desired surface.

The dispenser should have been shipped to you with a USB wall plug and a cable. When you are ready to use the dispenser plug in the wall adapter and insert the cable on the left side of the dispenser. Once you plug in your Altha dispenser it should power up and the LCD screen should display it is Unassigned and ready to go.

GETTING STARTED

Once the dispenser is plugged in, the dispenser screen will turn on. The time will appear on the dispenser and a cloud-icon should also appear to indicate that the dispenser is connected to the wireless network. The LCD screen should also display the dispenser identification number (e.g. Altha-xxx) which will be used every time you want to select the dispenser from the dispenser list. By pressing the volume or brightness button, you can open the dispenser to ensure it is empty and to allow you to clean it before loading a blister pack with the Altha custom blister top.

A newly received dispenser might need to be checked into your pharmacy location (in order to confirm that it is no longer in transit (see "Selecting A Dispenser")

Once a dispenser has been checked in, the following are some of the steps that may need to be taken to allow the patient to use the dispenser:

ASSIGNING the Altha dispenser to a patient
Creating a PATIENT RECORD
CONFIGURING the dispenser for use by the patient
Setting up special daily CUSTOM DOSING for medications if needed for a particular patient
Setting up AS NEEDED (PRN) DOSING if needed for a particular patient
Setting up NOTIFICATIONS for personal caregivers
Setting up supported BLUETOOTH HEALTH APPLIANCES (for example a blood pressure monitor or an oximeter) to allow vitals to be taken

You can also monitor the patient by looking at the log files which will allow you to monitor medication adherence and use of any connected Bluetooth health appliances (see PATIENT MONITORING and BLUETOOTH LOGS).

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SELECTING A DISPENSER

After successfully logging into your account, you will be able to view the "Dispensers" screen which displays a list of all the Altha dispensers associated with your pharmacy location. The list will show whether the dispensers associated with your pharmacy are In Transit, Unassigned, Provisioned or Deployed. If you want to assign a dispenser to a patient, you will have to use an unassigned dispenser.

The dispenser list is also a quick way to review how many doses have been taken, how many are remaining, the overall adherence to the drug regimen as well as issues that may have occurred for each actively deployed dispenser.

DISPENSER ASSIGNMENT

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The dispenser will arrive at the pharmacy in either an Unassigned state or an In Transit state. If a particular dispenser is in an In Transit state, simply select the "CHECK-IN DISPENSERS" button to associate the dispenser with your pharmacy.

After being checked in, the dispenser will be in an Unassigned state (as can be seen in the browser or on the LCD screen of the dispenser). With the dispenser turned on, use the dispenser identification number (e.g. Altha-xxx) to select the dispenser in the Dispensers screen just shown.

Once you select the correct dispenser you will be presented with the detailed dispenser screen. In this screen you can select the "ASSIGN DISPENSER" button to get the process started for using the Altha dispenser. NOTE: anywhere you see a "?" you can select this for additional help.

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THE DISPENSER VERIFICATION STEP

After logging in through the browser, the first step is to press the "ASSIGN DISPENSER" button located in the Patient section. After selecting ASSIGN DISPENSER, you will be asked to verify that you have the correct dispenser in your hands. To assign the dispenser to a patient, follow these steps:

Click the "GENERATE VERIFICATION" button.
Find the 4-digit code on the Altha dispenser’s LCD screen.
Enter the 4-digit code shown on the Altha dispenser into the four boxes that appear on the browser.
When the code is verified the "CONTINUE" button will be enabled on the browser and must be selected.

If the dispenser experiences network coverage issues during the verification process, the message "Dispenser appears to be disconnected" will be displayed in the "Verify Dispenser" dialogue box on your browser screen. If this happens move the dispenser to a new location with better coverage and again select "GENERATE VERIFICATION" to receive a new code (see the Troubleshooting section for further information if required).

SELECTING A PATIENT

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After the dispenser has been verified, the "Select Patient" screen will appear in your browser. Using this screen, you will be able to assign the dispenser to an existing patient (one that a dispenser has been previously assigned to or you added earlier) or you will be able to assign the dispenser to a new patient.

A) Assigning the dispenser to an existing patient

If dispenser is being assigned to an existing patient, then:

Select the patient’s name from the existing list of patients.
Once the patient’s name is selected, you can review that patient’s information and update it as required.
When assigning the dispenser to an existing patient you can add or remove information about personal caregivers who want to receive medication or Bluetooth health appliance alerts, or you can modify when or how (email or text) they receive alerts.
Select "SAVE" when the dispenser has been assigned to a patient and personal caregiver information has been updated as required.

B) If a patient is going to receive an Altha dispenser for the first time:

Select the "NEW PATIENT" (note selecting the CANCEL button will end the assignment process and return you to the previous screen if required).
A dialogue box will be presented in the browser where patient information can be populated. Only the patient’s name is mandatory and must be entered to save the patient’s information.
Enter an email address and /or cell phone number for the patient if they want to receive emails and/or text messages for dosing reminders and AlthaRx Alerts.
After filling in the necessary fields press the "SAVE" button to complete the patient record.
If a patient wants personal caregivers to receive alerts from the Altha system, then use the "ADD CONTACT" button to add each personal caregiver. Include an email address and/or phone number for support contacts that wish to receive alerts by email and/or SMS. Please note: no text or email notifications and alerts can be sent to support contacts if there is no email address or phone number for that contact.
Select the SAVE button when all information has been entered.

You can click on the “Θ” button as shown in the image above to remove personal caregivers and select "ADD CONTACT" to add multiple personal caregivers.

Once SAVE is selected, it is possible to load a blister pack into the dispenser immediately. The Altha dispenser display screen will change to indicate that a button can be pressed to unlock the top lid of the dispenser to allow the packaged blister it to be loaded. If you do not have a blister ready, simply use the MENU button on the dispenser to put the dispenser into power down mode and you can load the dispenser at a later time (See the Loading the Dispenser section for more details).

On the very bottom of the Altha dispenser is a clear pouch in which to place the patient’s prescription printout. It is helpful if you fold the prescription printout so that the patient’s name is showing on the outside to allow someone to quickly confirm that the prescription on the printout and the name on the dispenser matches.

Note: Once assignment is complete you can use the "MENU" button on the Altha dispenser to take the patient’s fingerprint. Alternatively, the patient can associate their fingerprint with the dispenser on their own at home. If additional information is required about associating a fingerprint with a particular dispenser visit the Fingerprint Guide in the Troubleshooting section.

If you experience any difficulties in assigning a dispenser to a patient see the Troubleshooting section.

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CONFIGURING

This section details how to set-up and change the configuration parameters that will guide the operation of the Altha dispenser. Configuring the system can be done before or after the blisters are loaded into the dispenser.

To get started follow these steps:

After assigning the dispenser to a patient select the "Dispenser Configuration" tab.
Once selected, the first step to configure a dispenser is to select a start date for the dispenser. (HINT: By clicking on the calendar icon, you can save time in selecting a date).

The start date requires that a filled blister pack be placed into the Altha dispenser before this date.The End Date that is shown represents the date on which that blister is expected to have been used up (based upon the duration for the blister which is selected by you).Please note that these fields will be automatically updated each week as a new blister pack is provided to the patient.

By default, when assigning an Altha dispenser to a patient the most common default configuration of 1 to 4 doses daily is assumed. If your patient takes only 1 to 4 doses daily then there are only a few mandatory fields that must be completed (Note: Visit the Custom Dosing and As Needed Dosing sections if you want to use the advanced dose regimens supported by the AlthaRx system).
When the patient will be using the blister for a seven-day period with 1 to 4 doses per day, you only need to enter the "Duration" and the relevant dosing periods. Any dosing period that is left blank will be skipped as it is assumed that the patient does not take a dose at that time. Up to 4 dosing times can be input corresponding to the Jones Healthcare Qube™ blister card. Remember: it is important to use the AlthaRx blister top when completing your loading process and sealing up the blister pack. See the on the custom blister top section if you would like more information on the custom Altha blister top.
Use "SHOW DOSE SUGGESTIONS" to provide an input box to enter a dose suggestion for any of the doses. For example, "Take with water", "Take sublingually" or "Take with food". These custom messages will appear on the patient’s Altha dispenser when the patient is dispensing that specific dose. (Note, hovering your cursor over "I" will allow you to review the customized message.
When you have completed inputting all parameters, select "SAVE" to send the information to the Altha dispenser.

If you want to use more advanced configuration parameters, the following are some options:

Sound Reminder – controls how long an alert sound will be played for the patient by the dispenser. The default is for 1 minute.
Late Dose Alert– controls how long before an alert is provided where there is a late/missed dose. This alert is provided by the dispenser and optionally via email and SMS to the patient and support contacts.
Low Dose Alert – controls whether an alert is provided on the dispenser and optionally via email or text to the patient and personal caregivers when the medication within the dispenser is running low. If a regular weekly blister pack schedule is in place, then this function will not be used frequently
Missed Dose Time – controls whether a maximum time will be used for determining if a dose should be considered missed so that the dispenser skips over that dose and only dispenses the next dose. When no time is entered then the current dose will be available until the next dose is due; for example, if the patient misses their evening dose, then it will still be available to them the next morning, until their morning dose is actually due. When set to a large value like 6 this value can limit the bedtime dose being taken in the morning.
Patient Early Dose – this defaults to Yes to allow the patient to dispense one or more doses ahead of schedule if they are going to be away from their dispenser when a dose is going to be due.
Max Early Removal – this indicates how many doses can be dispensed early by a patient. This defaults to 1 day which would allow a patient to remove the remaining doses for that day.
Fingerprint Bypass – allows a patient to bypass the fingerprint reader for medication dispensing. This feature has been included in case there is a fingerprint reading issue or concern.
Use Bypass PIN – this increases the security when the fingerprint bypass is enabled. This should be set to Yes if the patient is concerned about someone taking their medications.
PIN Sequence – when Use Bypass PIN is set to YES, the AlthaRx system will automatically generate one of 16 possible button press sequences for enabling the dispensing of medications without using the biometric fingerprint. The Altha dispenser will prompt for this button sequence when fingerprint bypass is used. The brightness and volume buttons on the dispenser will be used to input the button sequence.

Note: This sequence should be written down on the prescription card for the patient to easily access. This will provide an extra level of security in place of the fingerprint requirements for medication dispensing.

After selecting SAVE, these saved parameters will automatically be applied to subsequent blister packs that are loaded into the patient’s dispenser. To change any parameters after having saved them, select EDIT to enable the editing of the saved parameters.

If you have not already loaded the blister pack into the dispenser after clicking on the SAVE button, a message will be displayed on the screen of the dispenser reminding you to load the dispenser with the blister pack. The LCD screen on the Altha dispenser will guide your actions to ensure each step is completed.

Note: after assignment and configuration, it is possible to power-down the Altha dispenser for shipping to the patient. Use the "MENU" button located at the top of the Altha dispenser LCD screen to select this option. If you have not taken the patient’s fingerprint already, the dispenser will prompt you to take the patient’s fingerprint before power-down. If you cannot take the patient’s fingerprint, then you will be able to power down and the fingerprint prompt will reappear when the patient eventually powers up the dispenser. See the Fingerprint Guide section for more details.

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NOTIFICATIONS

Once the dispenser is assigned to the patient and information about their personal caregivers is entered, it is then possible to set up Notification and Alert settings. Notifications can also be changed, updated and adjusted at any time as the patient and their personal caregivers advise.

Notifications and alerts can be provided to the patient and any authorized personal caregivers based on the presence of a verified email address and verified cell phone number. All email addresses and cell phone numbers must be verified. To learn more about the verification process visit the Email Address and Text Message Verification section of the Troubleshooting section.

The first step in setting up notifications is to select the NOTIFICATION tab, located beside the Patient & Fingerprint Configuration tab. The patient will be listed first followed by each of the authorized personal caregivers. There will be an indication below the patient’s name and caregiver name for all email addresses or cell phone numbers that have not been verified.

In this example the patient’s email address and cell phone have been verified, but the caregiver email address has not yet been verified.

There are 7 different types of alerts that can be selected (as shown above). Once an email and cell phone have been verified, configured messages will start to flow to the authorized dispenser. You can select EDIT at any time to modify and change these settings as needed.

Appliance Alerts are used when a Bluetooth health appliance reading has not arrived before the configured ‘Server Alert’ time is reached.

Once all changes are complete, select the SAVE button to record the new settings.

CUSTOM BLISTER TOP

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The AlthaRx system requires the use of a custom blister top when sealing up the medications that are loaded in the blister bottom. These blister tops will have been provided to you by your AlthaRx representative when they signed you up for using the AlthaRx system. The custom blister top allows you to check what medications have been put into the blister by pulling the middle tab. Once the medications have been checked, push back the middle tab, and apply the security tape on the bottom side as shown. The tape should overlap both the stationary bottom boxboard material and the sliding middle tab section.

If you are loading the dispenser into the Altha dispenser, please leave the security tape on the blister pack so the patient can remove it.

After placing the blister pack into the dispenser, the patient can remove the security tape, then pull the exposed pull tab to allow their medication to be loaded into the dispenser. (Note the security tape allows the patient to verify that the blister pack has not been tampered with).

LOADING THE DISPENSER

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For both you and the patient the steps in loading the Altha dispenser are similar. Before the dispenser will complete deployment, it requires a loaded blister pack be loaded. You must use a custom Altha dispenser top to secure the medications into the dispenser plastic holder. You can open a dispenser you are preparing for deployment by pressing either the brightness or volume buttons as indicated by the dispenser LCD screen. If the patient is loading the dispenser, they will have to enter their fingerprint or perform a fingerprint bypass to unlock the lid. (NOTE: This process will also eject all unused medications for return to the pharmacy.)

Before you load your blister pack into the Altha dispenser, you must first remove the fold-over flap that covers the pills. This is perforated to allow for easy removal. Remove both the flap and the thin strip connecting the flap to the main blister pack holding medications After opening insert the blister pack upside down with medications on the upside as shown.

If you have used tape, ensure the end you have taped is sticking out of the dispenser (on the right side of the dispenser) when it is closed. You should be able to see the tab after it the dispenser is closed, as shown in the picture below.

Once the blister is loaded the security tape should be visible when used. This tape will be removed by the patient before they begin the dispensing process.

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BLUETOOTH APPLIANCES

The pharmacist can allow supported Bluetooth health appliances to connect with a deployed Altha dispenser. This allows for monitoring of vitals information for a patient. Currently the AlthaRx system supports the Bluetooth enabled blood pressure cuff manufactured by Beurer, product number BC57.

To enable this:

Select the BLUETOOTH CONFIGURATION tab on the tab line to get started.
Select the "EDIT" or "ADD BLUETOOTH DEVICE" button to bring up the supported Bluetooth appliances.

When the full dialogue box appears you can fill in the remaining configuration items:

Select the Appliance Type and Appliance Name from the list (as noted above currently only the Beurer BC57 is supported).
Enter a schedule for readings, three are supported including: None (Adhoc), Before and After dispensing and Specific times. Before and after dispensing allows readings to be directly tied to when the patient decides to take their medications. While specific times allows up to 4 specific reading times in the day.
Enter a reminder message corresponding to the desired action (for example, "please take your blood pressure now").
You can also enter a subsequent Alert time that will send a further reminder if the patient forgets to take their reading.

If you do not want to have readings before or after every single dose period, then please use the "Specific Times" option.

In this example readings have been requested after the morning, lunch and dinner dosing periods but not after the bedtime dosing period.

If you would like to assist the patient by setting up their Beurer BC57 blood pressure cuff, please review Connecting a Bluetooth Appliance in the Troubleshooting section.

PATIENT MONITORING

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Should you want to review a patient’s medication adherence there are two methods.

Looking at the dispenser list on the browser allows you to see high level information (see screen shot below) about all assigned dispensers at a quick glance. The following is an overview of the information on the dispenser list which are not self explanatory:

State: provides information about whether the dispenser is unassigned, deployed or in transit
Last Contact: specifies when the last message was sent from the AlthaRx system to the dispenser
Doses: shows the number of doses taken as compared to the total doses loaded in the dispenser
Altha Alerts: specifies the number of times the device received alerts like a low battery warning or an attempt by someone trying to tamper with the dispenser.

If you want additional information about a particular patient, you can click on the DOSE LOG tab to bring up specifics about every dose that has been taken or missed.

Clicking on a given dose line will show the specific dose dispensing time and dose retrieval time. Dose retrieval is associated with the opening and closing of the dosing flap to physically remove the pills from the bottom pill tray. Additional information and history can also be found in the detailed patient records as illustrated in the Patient History area of the Troubleshooting section.

CUSTOM DOSING

The AlthaRx system supports custom dosing regimens of between 1 to 8 doses per day. If fewer than 4 doses are given in a day, then custom dosing can allow a blister to be used for more than 7 days and if more than 4 doses are given in a day then the blister can only be used for less than 7 days.

For example, if a patient is only taking two doses per day, the blister pack could be made to last for up to 14 days. Alternatively, if the patient is taking 8 doses per day it would last only 3 days. In this latter case the first 24 blister slots would be full of medications and the last 4 blister slots would be empty.

When using a custom dosing regiment, empty dosing periods are NOT ALLOWED. When custom dosing is configured, this is considered a tight packing of the blister and every blister slot is filled with medications until a full day of medications can no longer be accommodated. For full details on how to use the Custom 1-8 dosing regimen visit Custom Dosing Details in the Troubleshooting section.

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AS NEEDED (PRN) DOSING

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The AlthaRx system provides support for an "as needed" (PRN) medication regimen. This feature is especially useful for supporting the appropriate use of pain medications and other high-risk medications that could be addictive like opioids, sleeping pills or barbiturates. Using this feature, you can carefully restrict how often the patient can take their medications to ensure over medicating is not possible. The As Needed regimen configuration supports both patient-guided self dosing and pharmacist-witnessed dosing.

When selecting "As Needed: PRN Doses" several of the earlier configuration parameters are not accessible. They will be disabled automatically once the "As Needed" regimen is selected. These parameters included Sound Reminder, Late Dose Alert, Missed Dose Time, Patient Early Dose and Max Early Removal since they are not necessary or are in conflict with an “As Needed’ dosing regimen.

The following are explanation for the parameters shown above:

Start Time – this parameter allows you to specify when the first dose of medication can be dispensed. For example, if the patient is just out of the hospital and comes into the pharmacy, they might not be allowed another dose of pain medication until a certain time (for example, to allow a proper time interval between doses).
Doses Loaded – this is a mandatory field and indicates how many total doses have been loaded into the blister pack. If the Low Dose Alert is used, it will track the total remaining doses in the dispenser based on this value. Note: it is useful to use the low dose alert for the as needed dosing regimen.
Maximum Days – this parameter allows you to set the maximum number of days the dispenser is allowed to dispense medications contained within a particular blister. For example, a physician might want to limit the patient’s ability to access pain medication to only 10 days.
Minimum Dose Interval – this is a mandatory parameter, and it defaults to 30 minutes. This parameter determines the shortest time interval between when two doses can be dispensed for the patient. This can be adjusted by you based on the desired time interval.
Maximum Doses – this parameter sets the maximum doses that can be consumed in a 24-hour period. This is not related to a specific day but to any 24-hour time period. For example, if the start time is 1:02pm then the 24-hour period will run until 1:02pm the following day.
Server Enables All Doses – this parameter is used with “witnessed dosing’, like when a patient is taking a medication like Suboxone or Methadone (in pill form). When using this feature, the patient will have to contact the pharmacist so that the pharmacist can authorize the dose (possibly while witnessing the patient on video). See the Witnessed Dosing section in the Troubleshooting section for greater detail on this process.
Use Drug Reminders – this parameter indicates when the dispenser will prompt the user to take their medication. When set to Yes, the recommended interval is used to determine when the reminder is provided to the patient and personal caregivers. This will also result in a dose reminder being sent 2 minutes after the timer is reached should no drugs be dispensed.
Recommended Interval – this parameter is used to provide guidance to the patient on when it is recommended that they take a medication. Unlike the minimum dose interval this would be considered the optimal dose interval for best results with that particular medication.
Dose Suggestion – this is a message that will be displayed when the patient is about to extract a dose of medication. This could be related to how the medication is to be consumed or about side effects from the medication.

TROUBLESHOOTING

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RESETTING THE ALTHA DISPENSER

If you are having issues with the dispenser, there are two ways to reset it to restart its operating system. The first is to hold down the left button for over 10 seconds and release the button. This will cause the LCD screen to go blank briefly while the system restarts. The second is to use a small object like an unfolded paper clip and insert the paper clip into the small hole located beside the USB plug on the dispenser. It is important to insert the object directly into the hole and avoid awkward angles or objects that are not straight.

POWER DOWN MODES

Depending on the state of a particular dispenser, several power down and sleep modes are supported. When in an unassigned state, the MENU button will provide a Power Down option and a Shipping Mode option. Power down can be used in most situations where the dispenser might not be used for a day or two (as this turns off some of the dispenser subsystems to help the battery to last for a day or two). For longer periods of storage or when shipping on a plane the Shipping Mode should be used. Shipping Mode will turn off all subsystems and prevents any long-term battery issues.

FINGERPRINT GUIDE

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After the dispenser is assigned, the user of the dispenser will need to register their fingerprint. During medication dispensing this will act as a biometric confirmation of who is taking out the medication. In most cases the user will be the person who is actually taking the medications. Occasionally, however, the user could be a caregiver, a PSW or even a family member.

The fingerprint can be registered in two ways. Immediately after assigning the dispenser to the patient the MENU button on the LCD screen of the dispenser can be used. Pressing MENU will show another button called Register Patient Fingerprint. Selecting this will allow you to register the patient’s fingerprint while they are in the pharmacy. If this is not done, the fingerprint registration will be automatically requested after a blister pack is loaded and the dispenser configuration is saved at the server.

The fingerprint registration requires two readings of the user’s fingerprint. Therefore, when registering a user’s fingerprint always place the same finger each time when prompted by the LCD screen of the dispenser. The fingerprint subsystem will re-prompt the patient for their fingerprint until it gets two good readings.

The fingerprint can be registered by you after the dispenser is assigned or can be set up by the user independently when they are ready to start using the dispenser.

If for some reason a fingerprint has not been provided and the first dose has come due the user can use the fingerprint bypass method to dispense their drugs. There is a local fingerprint bypass that is available through the MENU on the LCD screen of the Altha dispenser. There is also a fingerprint bypass available in the Medication section of the pharmacist detailed dispenser screen.

When a dose is not expected the button will read "ALLOW EARLY DOSE", but when a dose is ready the button label will change to "FINGERPRINT BYPASS" to indicate that the patient can take the dose without using their fingerprint.

If the patient is experiencing consistent failures when using the fingerprint reader, it is possible to retake their fingerprint. To do this, select the Patient & Fingerprint Configuration tab and press the "RETAKE PATIENT FINGERPRINT" button. It is important to have the patient on the phone during this procedure to ensure they are close to their dispenser and engage in the process. they should be advised to use the same finger twice when registering (using the same part of the finger each time). The index finger is the recommended finger to use.

CONNECTING A BLUETOOTH APPLIANCE

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Should you wish to connect the Buerer BC57 blood pressure cuff for the patient or assist the patient in doing so, the following are some guidelines which may be helpful.

In order to start using the Beurer BC57 blood pressure cuff, you will need to first insert the batteries into the device. Once you do this, you will be prompted to set the date, time and Bluetooth mode for the device. Consult the manual to ensure you set these values accurately and that Bluetooth mode is enabled. For best results add 1 minute to the current time when entering the time value. If you make a mistake, simply remove one battery and re-insert it to restart the configuration process.

After you assign the Beurer BC57 to a particular dispenser using the Bluetooth Configuration tab, the dispenser will display a RED Bluetooth icon as shown.

To connect the blood pressure cuff for the first time, follow these steps:

Select the MENU button shown on the dispenser’s LCD display, followed by the Bluetooth menu item on the next screen.
Select the Add New Bluetooth Device button and the following screen should appear indicating that the dispenser is ready to connect. Note that the process can be stopped at any time by pressing the BACK button.

After selecting the Add New Bluetooth Device button you will see the following screen:

Once you see this screen, press the "M" key on the blood pressure cuff and wait 5 seconds, then press the power button "Φ". Wait 5 more seconds and press the power button "Φ" again.

When the Beurer BC57 button appears on the dispenser’s LCD display, simply touch it and then press one of the two buttons on the dispenser to CONFIRM your selection. The dispenser will then return to the main LCD display and the Bluetooth icon will be displayed in BLUE.

Depending on the configuration settings the dispenser can also prompt the patient to take their blood pressure readings (as seen on the screen below) or if you don’t want to prescribe when those readings should take place, then the patient can take them whenever they want, and the readings will still be collected by the AlthaRx system.

To take a reading the following steps should be followed:

The patient should put on the blood pressure cuff and select the power button "Φ" and wait. The blood pressure cuff will automatically take the patient’s blood pressure and once this is complete the patient should press the power button "Φ" again. This will turn on Bluetooth so that the cuff can connect with the dispenser.
Once the cuff connects with the dispenser, the patient should select the MENU button, followed by the Bluetooth button. The following readings will appear on the LCD display:

The patient should select the "Take/Retrieve Reading" so that the reading from the blood pressure cuff so that the reading can be recorded within the AlthaRx system.
Once the reading is recorded the dispenser will emit a short beep and the screen will inform the patient of successful transfer of the data as follows:

Note: unless the patient is no longer going to be using the blood pressure cuff then the patient need not worry about using either the "Remove Bluetooth Device" or "List Known Bluetooth Device" functions.

BLUETOOTH LOGS

Selecting the BLUETOOTH LOGS tab will allow you to view all activity from connected Bluetooth health appliances. The example below shows before and after blood pressure readings for three dosing times for the patient.

Before each of the required readings the patient is given a visual and audible alarm to take their vitals by the dispenser.

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EMAIL ADDRESS AND TEXT MESSAGE VERIFICATION

When a patient provides an email address and cell phone number, the patient will have the choice of receiving emails and/or text messages that provide important dosing reminders and AlthaRx Alerts. When a patient authorizes one or more personal caregivers to receive notifications their email address and cell phone numbers will also be needed to enable this functionality.

Once the patient information has been filled in, enter the contact information for any personal caregivers by selecting "ADD CONTACT". Personal caregivers are people who the patient has consented to receive notifications about upcoming doses, late doses, missed doses, and AlthaRx Alerts, which includes various dispenser specific messages like power low and intrusion detection. It is important that the patient confirms that the personal caregivers have authorized the use of their email addresses and/or phone numbers.

Depending on the notification and alert selection, a verification email and/or text message will be sent to the provided email address and/or phone number to verify the contact information for the patient and the authorized personal caregiver(s).

The patient and/or personal caregiver(s) should be advised to click on the link provided in the verification email and/or text message to complete the verification process. If using email, the email should be found in the inbox otherwise the personal caregiver should be asked to check their junk or spam folder.

Initially the email address and cell phone will show a yellow hourglass icon on your browser which indicates that the AlthaRx system is waiting for verification of the contact information as described above. Once the email address and cell phone have been verified a green checkmark will be displayed next to the provided email address and/or phone number in the patient information section and support information section indicating that the verification was successful.

Note: If a patient and/or personal caregiver is receiving both email and text message notifications and alerts, they will have to verify a phone number and email address using the separate links provided.

The following are the formats for the verification messages:

Patient email verification format:

Patient text message verification format:

Personal caregiver email verification format:

Personal caregiver text message verification format:

By clicking on the verification link, the patient and/or personal caregiver will be redirected to a screen (below) where they must consent to receive notifications.

The verification process can be reinitiated if any problems arise. To resend a verification email and/or text message, click on the green checkmark or the hourglass that is shown next to the provided email address and/or phone number to reinitiate the verification process. Speak to your AlthaRx representative should you have any questions.

WITNESSED DOSING

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When witnessed dosing is required the "Server Enables All Doses" parameter can be used to limit access of medications by the patient. When this parameter is enabled, a pharmacist can enable each dose to be dispensed by the dispenser. Dispensing can be achieved with the pharmacist selecting the "ENABLE DOSE" button in the Medication section of the browser interface.

Once this is done the fingerprint button will glow and the screen will prompt the patient for their fingerprint confirmation. Fingerprint bypass is disabled when using the witnessed dosing method.

RESETTING THE ALTHA DISPENSER

CUSTOM DOSING DETAILS

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As discussed above, the AlthaRx system supports custom dosing regimens of between 1 to 8 doses per day. The following steps should be followed to complete the loading of a custom regimen blister:

Enter the duration for the blister.
Enter the Daily Doses needed for this regimen.
Fill in the times of day matching the daily doses, remember none can be left blank.
Use SHOW DOSE SUGGESTIONS to include any dosing guidance that might be needed.
Use the LOADING TEMPLATE button to help guide you when loading the blister pack.

The LOADING TEMPLATE button will help guide the loading of the medications. When this button is pressed you can select which dosing regimen you wish to see displayed. Remember, that for example, in an 8 dose per day regimen the blister pack will only last 3 days so the patient will need more than 2 blister packs per week.

After entering the custom dosing, you can select the SHOW TEMPLATE button to display a template which can guide the blister loading process. This screen can be also be printed if desired.

Note: to minimize errors the initial first dose has been placed on the day corresponding to the "start date" selected by the pharmacist. However, it is important to remember that only the initial dose will match the day titles along the top. Based on the number of doses per day, these titles can be mostly ignored after “N’ doses have been inserted. The titles have been printed to match the blister top to ensure each day is loaded correctly.

In this example Sunday May 1st was selected so Day 1, Dose 1 starts in the Sunday breakfast dose blister slot. The loading template then provides the 2 doses per day regimen and where to place the medications in each blister slot. Day 2 is also shown on the Sunday, in the dinner and bedtime blister slot locations, but these will be dispensed on the Monday as required. Following the template exactly as shown will allow the patient to receive doses in accordance with the configured dosing regimen. In this next example of 6 doses per day the blister pack can only last 4 days and there will be four empty blister slots at the very end.

The select period dialogue box will allow you to proceed into the future many weeks to generate many loading templates if you wish to build blisters packs in advance.

Note, in most standard browser windows you can select a menu item or press a control sequence like "Control P" to initiate a printing sequence of the displayed information.

PATIENT HISTORY

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The patient’s record within the AlthaRx system provides a listing of all previous blister packs and medication adherence results. This history can be viewed by entering the patient record using the "Patients" menu on the left side panel shown in your browser screen. After selecting a patient name a detailed view is provided of all previous blister packs. By clicking on a given deployment a detailed view of each medication dispensing time is listed. The listing shows up to 8 dosing periods per day even though less might have been configured for the patient.