Blind people, and those losing vision, have always had difficulty identifying their medications and telling them apart. Serious consequences can follow, when prescriptions, oral or injectable, are mistaken, and the wrong dose given. Very serious consequences can follow the misidentification and misdosage of insulin.
As a long-term solution, insulin manufacturers need to make insulin vials distinguishable from each other by type/duration, without sight. The drug companies have not been particularly interested in doing this. We have been left with our homemade Braille labels, rubber bands, tape, and other temporary "recognition systems."
A very partial solution has been the Roche VoiceMate blood glucose monitor, with its "talking insulin identifier" feature. This monitor reads the bar-codes on Lilly insulins--but not on any others, and, while quite functional, is very expensive. A more general solution is needed.
In September of 1999, Dr. Marc Maurer, president of the National Federation of the Blind, hosted a meeting at the National Center for the Blind, in Baltimore, Maryland. Representatives from the ASKO Corporation discussed and demonstrated a prototype of their ALOUD #100 Audio Labeling System.
First of a new class of "talking prescription containers," the ALOUD consisted of three components: The recording unit (in the possession of your pharmacist, to whom ASKO will provide it without charge), and the playback unit (kit cost: $78.75 for #100 player, charger, and several reusable "audio labels," each of which contains a memory chip.)
When your pharmacist prepares your medication, and creates a written label, an "audio label" is created also. With the ASKO recording unit, the pharmacist reads pertinent dosage information onto the Audio Label, as if into a tape recorder. Like recorded tape, the Audio Label is reusable--when your prescriptions change, the pharmacist can replace old information with new. And note, there is no language barrier--whatever language your pharmacist speaks can be easily recorded. Standard reusable "audio labels" cost $10.00 each, and the smaller labels (for insulin vials) will cost $5.00 each.
The original ALOUD, (the "Model #100") was very functional, but a bit large, all right for oral medications, but not particularly convenient for use with an insulin vial. As those of us who most need a "talking label" on our insulin are likely users of an adaptive insulin drawing device such as MediCool's Count-A-Dose, any "talking label" needs to not interfere with insulin drawing. The original ALOUD made using the Count-A-Dose inconvenient.
ASKO then shrank the Audio Label, to make it more convenient for blind diabetics. The new model, the Aloud #200, also does away with the separate recorder; each "playback unit" can now record new messages. The electronics are similar to those of the #100 (which is still available) but memory has been expanded--each audio label now holds 60 seconds of information. The ASKO #200 kit costs $88.50, including recorder-player, microphone, charger, 3 audio labels, adhesive pads to attach the labels, earbuds and instruction sheet). More #200 audio labels are available for $11.95 each.
A completely different approach to the same problem, far more high-tech, has been taken by En-Vision America, with its ScripTalk system. Like the Aloud System, the ScripTalk consists of recorder, playback unit, and labels; but where the Aloud stores and plays back the pharmacist's voice, the ScripTalk utilizes Radio Frequency Identification (RFID) technology, and encodes a microchip on the medication's label with the same information typed onto the label. When the patient scans the medication container, this computer-loaded information is detected by the user's scanner and played back through a voice synthesizer. As with the Aloud #100, the pharmacist determines the label content; the consumer can only play back the information.
The ScripTalk's "printer" (the "label-maker," which the pharmacist uses to encode the information) is expensive. A pharmacist will pay $4,000.00 to $5,000.00 for the system and training, and each label printed costs $1.75 each. The "Reader," sold to customers, is priced at $325.00. This is a voice synthesizer, not a voice recorder, and is available in English or Spanish at this time.
Because the ScripTalk's special microchip is in the label, no great bulk is added to the label or container, and an insulin vial with label attached should easily fit into adaptive measuring devices like the Count-a-Dose. They offer two label sizes (same chip) with the smaller label 1/2-inches by 3/4-inches specifically for small vials like insulin.
En-Vision's system, while far more expensive than its competitors, has two virtues: The specialized labels it requires are the least obtrusive of any system so far, and, their favorite selling point, the system "places the liability for providing correct information where it belongs, on the pharmacist."
A simpler, more limited approach is offered by Millennium Compliance Corp., maker of the Talking RX audio label. Although the Talking RX looks much like the Aloud, and stores spoken information on a digital chip, there is no separate "recorder"--each unit has the capacity to record. Where the Aloud requires a different "audio label" on each prescription, but only one playback unit, each Talking RX unit is self-contained, recorder and playback, and no separate "audio label" is required. You attach pillbox or insulin vial to the unit, and leave it there until you've finished that course of medication. They're inexpensive ($19.95 each, suggested retail); but if you take a lot of meds, you may need to buy a lot of Talking RX devices, a different Talking RX for each of your medications.
A modification of this device is sold separately as the E-Pill "Beep'N Tell." To the Talking RX, E-Pill has added an alarm clock, which sits on the pillbox's lid (so of course this system is not for insulin vials!).
The MedivoxRX "Rex" system shares features with the ScripTalk and the TalkingRX. "Recording Station" and playback unit are separate, and the playback unit is the special pill bottle itself. The bottles don't need to be put into a separate playback unit (each is its own player). The system records the speech of whoever is using it (so any language can be recorded). However, unlike the other voice-driven units, the "Rex's" battery is not rechargeable, and MedivoxRX calls the playback units "disposable talking bottles." The company claims each unit's battery should last about six months, or about 300 playbacks. The "Starter Kit" (Recording Station and three disposable talking bottles) costs $54.95 plus shipping, and more disposable talking bottles are available for $24.95 per set of three. MedivoxRX was founded by a blind man, and has taken positive steps, such as an accessible Web site (www.rxtalks.com) and cassette instructions for the "Rex." This is commendable.
All the systems have their pluses, and their problems. Although both the Aloud and the Talking RX are "lifetime" products, endlessly reprogrammable, and both are simple and relatively inexpensive, neither is particularly convenient for use with an insulin vial. The MedivoxRX has similar problems, plus the playback units are not rechargeable, and it is somewhat fragile in construction. All three of these are really too big to work well with adaptive measuring equipment, unlike the ScripTalk.
An alternative approach to medicine identification is demonstrated by the Israeli-made ASSISTec Voila and the American En-Vision ID-Mate. These machines scan bar codes and read out contents from stored memory. The VoiLa (for "Voice Label") comes with a set of tactile, raised barcodes you apply to medicines needing tactile ID, and then the needed information must be read into the unit for each (and of course the system could work on many other containers, such as food, paint or other liquids, or even music CDs. It holds approximately 13 minutes of memory, which the user may subdivide as needed. The VoiLa (U.S. release date May 2003), is priced at $190.00, available in the US from Adaptive Technologies; telephone: 978-462-3817; Web site: www.adaptivetech.net.
The ID-Mate 2 (scheduled availability: June 2003) is designed to work with the UPC ("Universal Price Code") barcodes already on most items. No special attachment or label is necessary. The system holds up to a huge 2.5 hours of digital voice memory, so there is room for lots of complex instructions. Also available is an "encrypted food database" that can provide, spoken, full nutritional breakdowns on any food package, when loaded into the machine. The ID-Mate 2 should cost $1,599.00, available from En-Vision America (address below).
Between these two systems, the VoiLa is perhaps best seen, like the insulin identifier in the AccuChek VoiceMate, as a label-reader, a "medicine identifier," while the vastly more complex ID-Mate 2 provides room for instructions, cautions, and in-depth information. As a consumer, you must determine your own need.
To conclude, our main interest has always been the ability to distinguish one insulin vial from another. Systems designed for pill bottles, such as the Aloud and Talking RX systems, are only partial answers for insulin identification. Most of the systems reviewed here require sighted intervention or "programming"--and until there is some way a blind person can reliably and independently tell insulins apart, without such aid, the job is not completed. Discuss your needs for such a device with your health care team, and stay tuned for further improvement!
ASSISTec Ltd.
12 Lochamei Hagetaot, Suite 27
Naharia, Israel 22102
Telephone: 972-4-900-0656
E-mail: [email protected]
www.assis-tec.com
ASKO Corporation
2 South St.
Stamford, NY 12167
1-877-732-9227
www.askocorp.com
En-Vision America
1013 Porter Lane
Normal, IL 61761
1-800-890-1180
www.envisionamerica.com
E-Pill, LLC
70 Walnut Street
Wellesley, MA 02481
1-800-549-0095
www.epill.com
MedivoxRX Technologies, Inc.
28 Saxony Road
Pittsford, NY 14534
1-866-798-2557
www.rxtalks.com
Millennium Compliance Corp.
PO Box 649
Southington, CT 06489
860-681-9277
www.talkingrx.com