US20130116526A1 - Handheld Blood Glucose Monitoring Device with Messaging Capability - Google Patents

Abstract

A patient monitoring network pertaining to blood glucose and other analyte measurements includes wireless blood glucose or other analyte measuring devices and a networked computer or server. Each monitoring device is associated with a patient and is configured to measure the glucose level or other analyte from a given blood sample via inserted test strips, transmit the measurements to the networked computer, and display received messages. The messages may relate to the current or past measurements, or may include an alert prompting the user of the monitoring device to order more supplies, such as test strips. The measurements received by the networked computer may be stored in a record of a database, which may be accessed by a remote computer. The remote computer may also access a script editor to edit certain scripts which produce certain messages sent to the monitoring device.

Description

BACKGROUND
• 1. Field of the Invention
• The invention relates to wireless medical devices for collecting information from patients at remote locations and, more particularly, to handheld glucose monitoring devices for wirelessly communicating blood glucose and other analyte readings from patients to a remote server and for communicating related information from the server back to the patients.
• 2. Background
• Diabetes is a metabolic disease in which a person has high blood sugar either due to the body's inability to produce insulin, or the cells inability to respond to insulin. The disease can cause numerous complications, both short-term and long-term, and ultimately death if not well treated. Diabetes is the seventh leading cause of death in the United States by disease with nearly 284,000 deaths reported in 2007.
• Medical expenditures on those living with diabetes in the United States have steadily increased every year. People with diabetes have medical costs that are nearly 2.5 times higher than those without the disease. From 1980 through 2007, the number of Americans with diabetes quadrupled from 5.6 million to 23.6 million, accounting for 8% of the total U.S. population. Based on these numbers, the U.S. has spent over 174 billion dollars on caring for those diagnosed with diabetes in 2007 alone, a figure that makes up nearly 40% of the worldwide cost for treating diabetes. U.S. spending on diabetes is expected to rise to over 336 billion dollars by the year 2034.
• One of the factors leading to high costs for diabetes treatment is the issue of patient non-compliance. It is vital that patients diagnosed with diabetes regularly measure their blood glucose levels throughout the day and self-administer insulin injections if necessary. Failure to do so can lead to more hospitalizations and potentially create further health problems, all of which increase medical costs. On average, the annual medical costs per patient are nearly 3000 dollars higher for non-compliant patients versus those who regularly track their blood glucose levels. It is therefore an important initiative to improve the level of patient compliance as it pertains to effective treatment for diabetes.
• Current treatment protocols and methods rely entirely on the self-motivation of the patient to measure and record the results of their blood glucose levels which requires a high level of individual attention.
• What is needed is a treatment protocol that improves patient compliance and improves treatment by facilitating real-time communication to and from the patient.
BRIEF SUMMARY
• In an embodiment, a blood glucose monitoring system is described. The system includes a handheld blood glucose monitoring device, a networked computer, and a rules engine running on the networked computer. The handheld blood glucose monitoring device has a glucose sensing subsystem configured to measure a blood glucose level in a blood sample, and a radio transceiver subsystem configured to receive blood glucose measurements from the glucose sensing subsystem and transmit the blood glucose measurements over a wireless communications link. The networked computer is configured to receive the transmitted blood glucose measurements. The rules engine executes at least one script in response to a received blood glucose measurement and produces a message to be sent back to the handheld blood glucose monitoring device.
• The exemplary configuration of a networked computer in a blood glucose monitoring system is described. The networked computer is configured to communicate via a network. The networked computer is configured to receive, via the network, blood glucose measurements from a plurality of remotely-located blood glucose monitoring devices. The networked computer is configured to store each measurement from a particular device in a record, corresponding to the particular device, of a database. The networked computer is configured to execute at least one script, in response to receiving the measurement from the particular device, to produce a message to be sent back to the particular device, and transmit, via the network, the message to the particular device.
• In an embodiment, a handheld blood glucose monitoring device is described. The device includes a glucose sensing subsystem, a radio transceiver subsystem, and a display. The glucose sensing subsystem is configured to measure a blood glucose level in a blood sample. The radio transceiver subsystem is configured to receive blood glucose measurements from the glucose sensing subsystem, to transmit the blood glucose measurements over a wireless communications link, and to receive over the wireless communications link a message returned to the handheld device in response to the transmitted blood glucose measurement. The display is configured to display blood glucose measurements from the glucose sensing subsystem and to display the message received from the radio transceiver subsystem.
• An exemplary method for monitoring blood glucose levels of a plurality of patients is described. The method includes receiving, at a computer via a wireless network, blood glucose measurements from a plurality of blood glucose monitoring devices, each device associated with a respective one of the plurality of patients. The method also includes storing each measurement from each device in a corresponding record of a database, wherein each record corresponds to a respective device. The method also includes executing, for each received measurement, at least one script associated with the respective record to produce a message to be sent back to the respective device. The method also includes transmitting the respective message to the respective device.
• In an alternate embodiment, the monitoring system of the invention can be used to monitor other analytes. For, example, the blood glucose sensor may be replaced with a sensor to monitor interstitial fluid glucose, blood coagulation factors, cardiac enzymes, catecholamines, and other biomarkers. Such alternate sensors may operate, for example, using electrochemical or colorimetric sensing techniques as would be apparent to a person skilled in the relevant art.
• In this alternate embodiment, the analyte monitoring system comprising a handheld analyte monitoring device and a networked computer. Similar to the blood glucose monitoring device, the analyte monitoring device includes an analyte sensing subsystem configured to measure an analyte from a patient, and a radio transceiver subsystem configured to receive analyte measurements from the analyte sensing subsystem and to transmit the analyte measurements over a wireless communications link. Similar to the blood glucose monitoring system, the networked computer is configured to receive the transmitted analyte measurements. A rules engine running on the networked computer is configured to execute at least one script in response to a received analyte measurement and to produce a message to be sent back to the handheld analyte monitoring device.
• In this alternate embodiment, the networked computer includes a database containing records corresponding to each one of a plurality of handheld analyte monitoring devices. Each database record identifies a plurality of messages personalized to a user associated with a particular handheld analyte monitoring device. Message sent back to the handheld analyte monitoring device is selected from the plurality of messages using the script executed by the rules engine.
• In yet another alternate embodiment, the monitoring system of the invention can be used to monitor other medical information including, for example, physiologic parameters such as heart rate, blood oxygen saturation, blood pressure, respiration rate, blood pressure, electrocardiographic (ECG) information including ECG morphology using a sensor in communication with an implantable cardioverter defibrillator, body temperature, and the like. Sensors for such physiologic parameters are known in the art and are commercially available.
BRIEF DESCRIPTION OF THE DRAWINGS/FIGURES
• The accompanying drawings, which are incorporated herein and form a part of the specification, illustrate embodiments of the present invention and, together with the description, further serve to explain the principles of the invention and to enable a person skilled in the pertinent art to make and use the invention.
• FIG. 1 illustrates a patient monitoring network according to an embodiment.
• FIG. 2 illustrates an embodiment of a blood glucose monitoring device.
• FIG. 3 illustrates a subsystem diagram of a blood glucose monitoring device according to an embodiment.
• FIG. 4 illustrates a state transition diagram of a blood glucose monitoring device according to an embodiment.
• FIG. 5 illustrates a screenshot of a glucose data summary according to an embodiment.
• FIG. 6 illustrates a screenshot of a clinical profile according to an embodiment.
• FIG. 7 illustrates a screenshot of a data summary on a plurality of patients according to an embodiment.
• FIG. 8 illustrates a screenshot of a script editor according to an embodiment.
• FIG. 9 is a diagram illustrating a method performed by a blood glucose monitoring device.
• FIG. 10 is a diagram illustrating a method performed by a networked computer according to an embodiment.
• FIG. 11 is a diagram illustrating a method performed by a blood glucose monitoring device.
• FIG. 12 is an example computer system in which the embodiments, or portions thereof, can be implemented as computer-readable code.
DETAILED DESCRIPTION
• Although specific configurations and arrangements are discussed, it should be understood that this is done for illustrative purposes only. A person skilled in the pertinent art will recognize that other configurations and arrangements can be used without departing from the spirit and scope of the present invention. It will be apparent to a person skilled in the pertinent art that this invention can also be employed in a variety of other applications beyond diabetes care.
• It is noted that references in the specification to “one embodiment,” “an embodiment,” “an example embodiment,” etc., indicate that the embodiment described may include a particular feature, structure, or characteristic, but every embodiment may not necessarily include the particular feature, structure, or characteristic. Moreover, such phrases do not necessarily refer to the same embodiment. Further, when a particular feature, structure or characteristic is described in connection with an embodiment, it would be within the knowledge of one skilled in the art to effect such feature, structure or characteristic in connection with other embodiments whether or not explicitly described.
• FIG. 1 illustrates an exemplary patient monitoring system ornetwork100 according to an embodiment.Patient monitoring network100 includes a plurality of n blood glucose monitoring devices104-1 to104-n, each associated a respective patient102-1 to102-n.Patient monitoring network100 further includes anetworked computer112 and aremote computer114. In an embodiment, each blood glucose monitoring device104-1 to104-ncommunicates wirelessly to a cellular telephone tower108 (“cell tower108”) via a respective wireless communications link106-1 to106-n. In an embodiment,cell tower108 communicates withnetworked computer112 via communications link110, andremote computer114 communicates withnetworked computer112 via communications link116.Communication links110 and116 can include any network or combination of networks including, for example, the global Internet, a wide area network (WAN), metropolitan area network (MAN), wireless network, telephone network, or local area network (LAN).
• Networked computer112 may include, for example, one or more standalone computers, a server, a virtual server, a server farm, or a cloud-computing server. In an embodiment, wireless communications link106 may use any transmission means, or combination thereof, known to a person skilled in the art which include, for example, WiFi, Bluetooth, satellite, 3G cellular, 4G cellular, etc. In one preferred embodiment, communications link106 includes 3G cellular communications.
• A patient using a bloodglucose monitoring device104 withinpatient monitoring network100 may usedevice104 to take a reading (i.e., a measurement) of their blood glucose level from a blood sample. The measurement can be transmitted tonetworked computer112, where the measurement is stored in a record of a database. Each stored record is associated with a particular patient. In an embodiment, the bloodglucose monitoring device104 can also receive one or more messages transmitted from thenetworked computer112. In an embodiment, bloodglucose monitoring device104 receives a message as a result of transmitting a glucose reading tonetworked computer112. The received one or more messages may contain information relating to the most recent blood glucose measurement, information relating to past blood glucose measurements, and/or one or more personalized messages for the particular patient associated with the blood glucose monitoring device. In another example,networked computer112 tracks the number of glucose test strips used by the patient (based on, for example, the number of blood-glucose measurements uploaded fromdevice104 to networked computer112) and, when the number of test strips remaining is low (e.g., determined, for example, by comparing the number of measurements to a threshold value), transmits a low-supply message to bloodglucose monitoring device104, thereby alerting the patient to order more test strips. In addition, the patient may use bloodglucose monitoring device104 to transmit a response to the one or more messages back tonetworked computer112. The response may include, for example, an order for more test strips. Test strip usage tracking and replacement strip ordering is discussed in more detail below.
• One or more of the records (e.g., an authorized subset of records) stored on the database ofnetworked computer112 may be accessed viaremote computer114.Remote computer114 may be any device capable of accessing and displaying the records stored on the database ofnetworked computer112 including, but not limited to, a smartphone, a computer (e.g., a personal computer or PC), a tablet PC, etc. In an embodiment, a patient may useremote computer112 to access their own record. The record may contain summaries of all of the patient's past blood glucose readings in various graphical formats and can allow customization by the patient as is explained in more detail below. In an embodiment, a caregiver may useremote computer112 to access the records of all the patients under supervision of the caregiver. The caregiver may have access to graphical summaries and data lists of blood glucose readings for all of their patients. In an embodiment, the caregiver accesses a script editor to allow for customization of messages to be transmitted to each bloodglucose monitoring device104 and when each message is to be transmitted. The utility of the script editor is explained in more detail below.
• FIG. 2 depicts left-side, front-side and right-side views of an embodiment of a bloodglucose monitoring device104. Bloodglucose monitoring device104 includes adisplay202, aconnection port204, atest strip port206, apower button208, and aSIM card door216. In an embodiment, bloodglucose monitoring device104 also includes a user interface (e.g., to receive user input) which comprises buttons along the side of bloodglucose monitoring device104. The buttons may include an upbutton210, an enter (or select)button212 and adown button214. In another embodiment,display202 may be a touch-screen display (i.e., a touch-sensitive display) to act as the user interface in lieu of or in addition to buttons210-214.
• Display202 may utilize any technology known to those skilled in the art, including, but not limited to, LCD, OLED, TFT LCD, etc. In an embodiment,display202 is configured to show the most recent blood glucose reading taken by bloodglucose monitoring device104.Display202 may also show a graphical indication of a comparison between the most recent blood glucose reading taken and a target blood glucose level. In an embodiment,display202 shows any messages received fromnetworked computer112.
• Test strip port206 allows for the insertion of a blood glucose test strip. Blood glucose test strips are disposable strips used to collect a small blood sample from a patient as is known by those skilled in the art. The test strip may contain chemicals which react with the glucose present in the blood and produce a calibrated current response curve to an applied voltage. The calibration curve is generated by calibrating each manufactured test strip lot against known blood standards using a laboratory reference instrument, such as a Yellow Springs Instrument (YSI) glucose analyzer. This calibration curve is converted to a calibration code that is imprinted on the glucose test strip using conductive ink in order to enable bloodglucose monitoring device104 to identify the correct calibration curve to apply to the signal generated by the test strip, according to an embodiment. A total of seven (7) calibration curves are stored inside the firmware of bloodglucose monitoring device104, according to an embodiment. In one example, identification of code and selection of calibration curve is performed automatically upon placing the test strip intotest strip port206, and no code number is displayed to the patient.Power button208 may be any suitable switch to turn the power on and off to the device including, but not limited to, a slider, a toggle switch, a push button, etc. It should be understood that althoughpower button208 is illustrated inFIG. 2 to be located on the side of bloodglucose monitoring device104,power button208 may be located anywhere on bloodglucose monitoring device104.
• SIM card door216 may be used to protect a subscriber identity module (SIM) card placed therein. The use of SIM cards is well known to a person skilled in the art. In an embodiment, the SIM card within bloodglucose monitoring device104 allows unique identification of bloodglucose monitoring device104 withinpatient monitoring network100.
• Each button associated with the user interface of bloodglucose monitoring device104 allows the patient to provide input. For example, upbutton210 and downbutton214 may be used to scroll through menu options displayed ondisplay202, whileenter button212 allows for the selection of a particular menu option. In another example, upbutton210 and downbutton214 may be used to scroll through answer options for a message received fromnetworked computer112 and displayed ondisplay202, whileenter button212 may be used to choose an answer option and execute the transmission of the chosen answer option tonetworked computer112. In another example, the user interface may be utilized by the patient to facilitate the ordering of more test strips upon receiving a message alerting the patient to order more. It should be understood that although upbutton210,enter button212, and downbutton214 are illustrated inFIG. 2 to be located on the side of bloodglucose monitoring device104, each button may be located anywhere on bloodglucose monitoring device104. Further, these three buttons may be implemented as features of a touch-sensitive display.
• FIG. 3 illustrates a subsystem-level block diagram300 of bloodglucose monitoring device104. Subsystem diagram300 includes, at a high level, aglucose sensing subsystem302 and aradio transceiver subsystem304. In an embodiment, the components ofglucose sensing subsystem302 are configured to measure a blood glucose level from a blood sample on a test strip placed intotest strip port206. In an embodiment, the components ofradio transceiver subsystem304 are configured to receive blood glucose measurements fromglucose sensing subsystem302, and transmit the blood glucose measurements tonetworked computer112 over a wireless communications link. In an embodiment,radio transceiver subsystem304 is further configured to receive over the wireless communications link a message in response to the transmitted blood glucose measurement.Radio transceiver subsystem304 may include a cellular radio, either CDMA or GSM, using GPRS data transmission protocols for communicating over the wireless communications link.
• In an embodiment, athermistor306 is included withinglucose sensing subsystem302 for ensuring that the temperature withindevice104 is within the correct range for taking a blood glucose measurement. In an embodiment, astrip detector unit308 is also included to determine the type of test strip inserted and to measure the current response from the test strip. In one example,strip detector unit308 includes calibration data for seven (7) different test strip codes. In an embodiment, avoltage reference310 is applied to the test strip electrodes during the measurement. In one example,voltage reference310 has a value of 415 mV. Amicroprocessor312 controls operation ofglucose sensing subsystem302.
• Amicrocontroller320 withinradio transceiver subsystem304 controlsradio transceiver subsystem304. In one preferred embodiment,microcontroller320 controls all of the components within bothradio transceiver subsystem304 andglucose sensing subsystem302. In an embodiment,level translator414 is included to translate the voltage level betweenmicroprocessor312 andmicrocontroller320. In an embodiment,microcontroller320 interfaces with numerous components such as aSIM card322, aspeaker334, anantenna338, auser interface336, and adisplay module342. In an embodiment, apower switch330 is used to control power provided from abattery328 to the components ofdevice104 including avoltage detector332 and avoltage regulator bank340.Voltage regulator bank340 may comprise one or more low drop out (LDO) voltage regulators, the use of which is well know to those skilled in the art.Voltage regulator bank340 provides stable low voltage levels tomicrocontroller320,microprocessor312 anddisplay module342.Voltage regulator bank340 also provides stable low voltage levels to displaymodule342 via a DC toDC converter344. In an example,voltage regulator bank340 provides voltage outputs of 3 V, 2.8 V or 1.8 V.
• Antenna338 may be any antenna suitable for use within a standard mobile communications device such as a 2G cellular telephone. Examples of antennas include, but are not limited to, patch antennas, strip antennas, ceramic antennas, dipole antennas, whip antennas, etc.
• Components which exist external to the blood glucose monitoring device include anAC adapter316 for providing useable current from a common electrical outlet, and aconnector318 for connectingAC adapter316 toconnection port204 ofdevice104.Connector318 may be any suitable connector that can exist between two electronic or electrical sources including, but not limited to, USB, micro USB, IEEE 1394 (Firewire), etc. In an embodiment,connector318 may be used to linkconnection port204 to a computer.Connection port204 is configured to allow current to flow to either abattery charger326 or avoltage regulator324.
• FIG. 4 illustrates a state transition diagram400 illustrating an example mode of operation of bloodglucose monitoring device104 according to an embodiment. The blood glucose monitoring device begins in the power offstate402. Startingstate404 is transitioned to when the power button on the blood glucose monitoring device is pressed (B_P) and further transitions to aninitial state406.Initial state406 transitions to a waiting forstrip state408 without any input from the patient.
• Atstate408, a message is shown on the display of bloodglucose monitoring device104, prompting the patient to insert a test strip into the test strip port. In an example, pressing any button (B_any) associated with the user interface ofdevice104 transitions fromstate408 to amenu state412. In another example,state408 transitions to anidle state410 if no action is taken within a threshold time period. The threshold time period is, for example, 30 seconds. Inserting a test strip (Strip_I) causesdevice104 to transition fromstate408 to samplestate414.
• Atstate412, menu options are shown on the display of the blood glucose monitoring device.State412 transitions tostate410 if no action is taken within a threshold time period. As mentioned above, the threshold time period is, for example, 30 seconds. A patient may use the user interface on the blood glucose monitoring device to prompt the device to wait for a test strip (B_E) which causes a transition fromstate412 tostate408. Inserting a test strip (Strip_I) will also transitiondevice104 fromstate412 to samplestate414.
• Atstate410,device104 enters an idle mode and shuts the power off to the display in order to conserve energy. Pressing any button (B_any) associated with the userinterface transitions device104 fromstate410 tostate406. Inserting a test strip (Strip_I) causesdevice104 to transition fromstate410 to samplestate414.
• Atstate414,device104 waits to receive a blood sample on the test strip which has been placed into the test strip port. Removing the test strip (Strip_O) before a sample has been placed on the test strip causes a transition fromstate414 tostate408.State414 transitions tostate410 if no action is taken within a threshold time period. Again, the threshold time period is, for example, 30 seconds.State414 transitions to sampleexecution state416 once a blood sample has been placed on the test strip (Apply_S).
• Atstate416, the blood glucose level is measured from the sample. If the test strip is removed prior to the completion of the sample analysis, then state416 transitions to astrip error state418. If the measurement of the blood glucose level from the sample is completed,state416 transitions totransmission state420.
• Atstrip error state418, a message is shown on the display ofdevice104 alerting the patient that a measurement error occurred.State418 transitions tostate408 to wait for a test strip to be placed back into the test strip port.
• Atstate420, the glucose measurement is transmitted to a networked computer in order to be stored in a patient's record within a database. The glucose measurement is shown on the display ofdevice104.State420 transitions to endingstate422 when the test strip is removed (Strip_O).
• The state transitions ofdevice104, illustrated in the exemplary embodiment ofFIG. 4, are controlled by a computer program (e.g., software and/or firmware) residing inmicroprocessor312 or, alternatively, in a memory (not shown) associated withmicroprocessor312.
• Referring back toFIG. 1, blood-glucose measurements from a plurality of monitored patients are stored in a database innetworked computer112. The database can then be accessed byremote computer114 for analysis of the blood-glucose measurements. For example, in connection with analysis and/or display of the blood-glucose measurements onremote computer114,FIGS. 5-8 shows exemplary screenshots that may be shown on a display associated withremote computer114. It should be understood that any text or graphics shown are examples of possible text or graphics. A person skilled in the art would be capable of altering presentation of the blood-glucose data to achieve the same goals described herein without departing from the spirit or scope of the present invention.
• The exemplary screenshots displayed inFIGS. 5-8 are associated with a computer program executed by a processor withinremote computer114.
• FIG. 5 illustrates a patientdata summary screen500 displaying glucose readings for a particular patient. The top portion of patientdata summary screen500 displays apatient name502 associated with the record being shown, adate504, apatient menu bar506, asettings button505 and anupgrade button507. The middle portion of patientdata summary screen500 displays anaverage readings section508, a latest readings table510, areading summary512, areading history514, and anaverage readings graph516. The bottom portion of patientdata summary screen500 displays alatest messages section518 and aprint report section520.
• Date504 may be associated with the date that the patient activated their account withinpatient monitoring network100. Alternatively,date504 may be associated with the last time the record had been accessed by the patient. Any other dates of interest for the patient may be displayed asdate504.
• Patient menu bar506 may display icons allowing the user to navigate to other pages. For example, one icon returns the user to patientdata summary screen500 when selected. Another icon, when selected, may navigate a user to a friends page allowing the user to select email addresses of others who would be allowed to view their record. Another icon, when selected, may navigate a user to a profile page, which allows the user to change basic profile information associated with the record such as the patient's name, patient's address, etc. Another icon, when selected, may navigate a user to a support page which allows the user to contact a technical support group for the software. Another icon, when selected, may allow the user to log out of the software program.Patient menu bar506 may continue to exist at the top of the page regardless of the content shown on the rest of the page.
• Settings button505 may be selected to display a drop-down menu providing various menu options. For example, menu options such as messaging, clinical profile, or an HCP (health care provider) log may be displayed. The HCP log may include a list of all the dates and times that a licensed healthcare professional has accessed the current record.
• In an embodiment, selecting the messaging menu option navigates the user to a page allowing the user to choose which default messages are sent to the blood glucose monitoring device associated with the record. In an embodiment, default messages are sent to the blood glucose monitoring device in response to a blood glucose measurement being transmitted by the device. Default messages may contain information relating the most recent blood glucose measurement to past measurements taken by the blood glucose monitoring device or information relating to a completion percentage of prescribed blood glucose measurements for the day.
• In an embodiment, selecting the clinical profile menu option navigates the user to a patientclinical profile screen600 exemplarily illustrated inFIG. 6 and described in more detail below.
• In an embodiment, selecting the HCP log menu option displays a listing of dates and times that the record has been accessed by a licensed healthcare professional associated with the patient.
• In an embodiment,upgrade button507 searches the interne or any network for a software upgrade to the currently running program. If a software upgrade is found, the program may automatically install the upgrade.
• Average readings section508 may display information regarding the stored history of blood glucose measurements taken with the blood glucose monitoring device associated with the record. For example, information displayed may include an average blood glucose level, an average number of tests performed each day, or a compliance percentage.
• Latest readings table510 may display a list of blood glucose readings in chronological order taken with the blood glucose monitoring device associated with the record. In an embodiment, the most recent reading is shown at the top. In an embodiment, a side slider bar is used to scroll through the list of readings.
• Readingsummary512 may display values of particular interest to the user. For example, readingsummary512 may display the highest and lowest blood glucose readings taken. In another example, readingsummary512 may display percentages relating to how many blood glucose readings have had levels which were low, normal, high, or very high.
• Reading history514 may display average blood glucose readings during a variety of events. Example of events may include before and after meals, before and after exercising, before and after having a snack, etc.Reading history514 may display averages taken over a customizable time period. In an embodiment, readinghistory514 may display averages taken over 7 days, 30 days, or 90 days. In an embodiment, readinghistory514 displays blood glucose readings for a specific day.
• Average reading graph516 displays average blood glucose readings taken over a customizable time period in any graphical format. Examples of graphical formats include, but are not limited to, line graphs, scatterplots, bar graphs, etc.
• Received messages section518 may display a list of the most recent messages received by the blood glucose monitoring device associated with the record. The messages may include any type of message including default messages, personalized messages, triggered messages, or messages alerting the patient to order more test strips. In an embodiment, the time that the message was received is also included with each message displayed.
• Print report section520 allows the user to create a printout of the record. The record may be transferred into any suitable file format to be printed including, but not limited to, ADOBE PDF file, .txt file, .doc file, etc. The printed record may be chosen to include glucose reading data over a certain time period. For example, the printed record may include glucose reading data over the past 7 days, past 30 days, or past 90 days.
• FIG. 6 displays an embodiment of patientclinical profile screen600 which may include patient name602 and date604 as previously described. Patientclinical profile screen600 may also include anormal range input606, a maxhigh value input608, atime period610, and agraphical slider bar612. As illustrated inFIG. 6, patientclinical profile screen600 may include a plurality of the noted elements for different time periods. The various elements associated with each time period may each be changed by the user separately between the different time periods. Patientclinical profile screen600 may also include an update button614.
• The patient clinical profile allows the user to select which blood glucose reading ranges should be considered to be low, normal, high, or very high at various time periods throughout the day. This level of customization is important since nominal blood sugar levels may vary from user to user depending on numerous factors such as genetics, daily habits, etc. Examples of time periods include before or after a meal, before or after exercising, and at night before going to sleep.
• Normal range input606 may include two text fields allowing the user to input the range of blood glucose levels that should be considered “normal” for the given time period. Maxhigh value input608 may include a single text field allowing the user to input the maximum blood glucose level that is considered to be in the “high” range. Once all inputs have been entered, during the associated time period, any blood glucose measurement below the inputted normal range will register as a “low” reading, any measurement between the normal range will register as a “normal” reading, any measurement higher than the normal range but lower than the max high value will register as a “high” reading, and any measurement higher than the max high value will register as a “very high” reading.
• Graphical slider bar612 may be shown to graphically display the various glucose range settings for eachtime period610, wherein each range is separated by widgets613a-c. In an embodiment,graphical slider bar612 may be used to input the glucose ranges for each time period by sliding widgets613a-calonggraphical slider bar612.
• Update button614 is used to submit the changes made to the clinical profile. The program returns to patientdata summary screen500 after the user selects update button614.
• FIG. 7 displays an embodiment of a caregiverdata summary screen700 which includes agraphical summary section702, acaregiver menu bar708, and apatient list710.Graphical summary section702 may further include one or more of apatient summary graph704 along with acorresponding graph legend706.
• Caregiverdata summary screen700 is provided to assist caregivers in monitoring a plurality of their patients, each with an associated blood glucose monitoring device. At the top of caregiverdata summary screen700,caregiver menu bar708 may be provided to display icons which allow the user to either navigate to other pages or to access drop down menus. For example, one icon may produce a dropdown menu containing menu options for the data to be displayed ingraphical summary section702. In another example, one icon may navigate the user to a page listing all of the patients that have received a referral by the logged-in caregiver. In another example, one icon may navigate the user to an administration page, which allows the user to change their basic profile information, set which default messages should be sent out to all patients, and access a script editor as will be discussed in more detail below. Another icon, when selected, may allow the user to log out of the software program. In an embodiment,caregiver menu bar708 may continue to exist at the top of the page regardless of the content shown on the rest of the page.
• Graphical summary section702 may contain one or more graphs displaying data relating to all of the patients under supervision of the logged-in caregiver. Examples of graphs include, but are not limited to, pie graphs, line graphs, bar graphs, scatterplots, etc. Examples of patient data to display include age, type of diabetes, gender, state of residence, average blood glucose level, and compliance. In the illustrated example ofFIG. 7,patient summary graph704 is a pie chart withcorresponding graph legend706.Patient list710 includes a listing of each patient associated with the logged-in caregiver.Patient list710 may provide various information about each patient including, but not limited to, phone number, type of diabetes, activation date, average blood glucose level, prescribed number of daily tests, compliance percentage, most recent blood glucose reading, etc.
• FIG. 8 illustrates an embodiment of ascript editor800.Script editor800 may be accessed via an administration page as previously described. In an embodiment,script editor800 includes apersonal message field801, readingthreshold802, aniteration threshold804, amessage field806, an enablecheckbox808, adelete button810, and asave button812. It should be noted thatscript editor800 may be used to create one or more different scripts to be executed.
• Script editor800 allows the user to make changes to scripts executed by a rules engine onnetworked computer112. The scripts are executed in response to received blood glucose readings from a blood glucose monitoring device and may return a triggered message if certain criteria is met. The criteria as well as the content of the triggered message may be changed usingscript editor800. Regardless of whether the criteria is met or not, the executed scripts will return any enabled default messages or personalized messages to the blood glucose monitoring device in response to a received blood glucose reading.
• Readingthreshold802 may display a dropdown menu when selected. The associated dropdown menu may allow the user to choose between various blood glucose reading identifiers such as, for example, “Low”, “Normal”, “High”, etc. Similarly,iteration threshold804 may include a dropdown menu when selected to choose a number of consecutive readings that fit the identifier chosen in readingthreshold802. When the criteria comprisingreading threshold802 anditeration threshold804 are met upon receiving a blood glucose measurement, a triggered message comprising text entered intomessage field806 is sent to the blood glucose monitoring device.
• In an embodiment,script editor800 is used to edit the scripts for all patients under supervision of the logged-in caregiver. In another embodiment,script editor800 is used to edit different scripts for each patient under supervision of the logged-in caregiver.
• As an example, a script for a particular patient includes readingthreshold802 set to “Very High”,iteration threshold804 set to “5”, andmessage field806 containing the text, “You have tested very high 5 straight times. Please call me!” In this example, if the particular patient transmits a “Very High” blood glucose measurement five straight times using a particular blood glucose monitoring device, than the script will produce the triggered message entered intomessage field806 and transmit the triggered message to the particular blood glucose monitoring device.
• Enablecheckbox808 may be used to either enable or disable the associated script. If disabled, the triggered message will not be sent to the blood glucose monitoring device even if the criteria had been met. The script may be re-enabled at any time.Delete button810 may be used to delete the associated script.
• Script editor800 also allows a user to enter a personalized message intopersonal message field801. A personalized message may be associated with only a particular patient. In one embodiment, the personalized message will be transmitted to the blood glucose monitoring device associated with the patient upon receiving the next blood glucose measurement from the blood glucose monitoring device. In another embodiment, the personalized message is transmitted to the blood glucose monitoring device immediately after selecting a submit button (not shown) displayed withinscript editor800.
• Savebutton812 may be selected by the user to save the changes made inscript editor800. Selecting savebutton812 returns the user to caregiverdata summary screen700.
• FIG. 9 illustrates anexemplary measurement method900 performed by bloodglucose monitoring device104 after taking a blood glucose measurement. It should be understood thatmeasurement method900 can be one of many methods performed bydevice104 either in parallel or sequentially.
• Atblock902, a measurement is performed via the glucose sensing subsystem within the blood glucose monitoring device according to an embodiment. The glucose sensing subsystem applies a reference voltage to the blood sample and measures a current response produced from an electrochemical reaction on the test strip. The measured current is compared to a calibration curve and is translated into a voltage, the magnitude of which corresponds to the glucose level in the sample.
• Atblock904, the voltage calculated atblock902 is sent to the radio transceiver subsystem within the blood glucose monitoring device. The radio transceiver subsystem generates a signal which is modulated by the voltage.
• Atblock906, the signal which has been modulated by the voltage is wirelessly transmitted to a networked computer. The signal may be encrypted by the radio transceiver subsystem prior to transmission. Any encryption technique known to those skilled in the art may be utilized including, but not limited to, two-factor authentication, 128-bit encryption, etc. The signal received by the networked computer may be decrypted by the networked computer, and the data relating to the blood glucose measurement may be stored in a record within a database on the networked computer. Atblock908, one or more messages returned from the networked computer are received by the radio transceiver subsystem in response to the measurement transmission atblock906. The one or more messages may include any of the message types previously described including default messages, triggered messages, personalized messages, or a low-supply message alerting the user to purchase more test strips. The low-supply alert may include an offer to purchase strips. Further, a user/patient may place an order by responding to the low-supply message viadevice104. Networked computer may be configured to receive the order and to initiate a business process that will result in fulfillment of the order, including shipping the ordered test strips to the user/patient associated with theparticular device104 from which the order was placed. In addition to ordering test strips, the networked computer may send a message todevice104 that includes an offer to order related supplies for use with the particular device. Still further, the user may be prompted or provided with an offer to order other merchandise related to his/her needs but not necessarily related to any medical condition.
• FIG. 10 describes anexemplary server method1000 performed by a networked computer upon receiving a glucose measurement from a blood glucose monitoring device. It should be understood thatserver method1000 can be one of many methods performed by a networked computer either in parallel or sequentially.
• Atblock1002, a blood glucose measurement sent from the blood glucose monitoring device is received by the networked computer. The received signal is demodulated/decoded to retrieve for analysis the data relating to the measured blood glucose level.
• Atblock1004, the retrieved blood glucose level is stored in a record of a database. Each record corresponds to a unique blood glucose monitoring device. The records may be accessed by a remote computer and graphically displayed through a software program executed by a processor on either the networked computer or the remote computer.
• Atblock1006, at least one script is executed to produce one or more messages to be returned to the blood glucose monitoring device. In an example, a script may be executed to compare past measurements and determine whether a triggered message should be sent. In another example, a script may be executed to produce a personalized message. In another example, a script may be executed to track the number of test strips remaining associated with the blood glucose monitoring device. If the number of test strips is below a certain threshold, a low supply message is produced alerting the patient associated with the blood glucose monitoring device that they are running low on supplies. As discussed above, the networked computer may transmit an offer to order more test strips (or other merchandise), if the number of test strips is below a certain threshold. It should be understood that after all scripts have been executed, a message may not necessarily be produced and returned to the transmittingdevice104.
• Atblock1008, the networked computer determines whether the criteria have been met to send a triggered message.
• Atblock1010, the criteria associated with one or more triggered messages has been met. The one or more triggered messages along with any default messages, personalized messages, or low supply messages are transmitted to the blood glucose monitoring device.
• Atblock1012, the criteria associated with any triggered message has not been met. Any default messages, personalized messages, or low supply messages are transmitted to the blood glucose monitoring device.
• FIG. 11 describes an exemplary receivedmessage method1100 performed by bloodglucose monitoring device104. It should be understood that receivedmessage method1100 can be one of many methods performed by the blood glucose monitoring device either in parallel or sequentially.
• Atblock1102, one or more messages are received by the radio transceiver subsystem within bloodglucose monitoring device104.
• Atblock1104, the one or more messages are sent to the display of bloodglucose monitoring device104. The messages may be displayed in any suitable format, such as one at time, allowing the user to scroll through them, or concatenated together into one message, etc.
• In an alternate embodiment, the monitoring system of the invention can be used to monitor other analytes. For, example, the blood glucose sensor may be replaced with a sensor to monitor interstitial fluid glucose, blood coagulation factors, cardiac enzymes, catecholamines, and other biomarkers. Such alternate sensors may operate, for example, using electrochemical or colorimetric sensing techniques as would be apparent to a person skilled in the relevant art.
• In this alternate embodiment, the analyte monitoring system comprising a handheld analyte monitoring device and a networked computer. Similar to the blood glucose monitoring device, the analyte monitoring device includes an analyte sensing subsystem configured to measure an analyte from a patient, and a radio transceiver subsystem configured to receive analyte measurements from the analyte sensing subsystem and to transmit the analyte measurements over a wireless communications link. Similar to the blood glucose monitoring system, the networked computer is configured to receive the transmitted analyte measurements. A rules engine running on the networked computer is configured to execute at least one script in response to a received analyte measurement and to produce a message to be sent back to the handheld analyte monitoring device.
• In this alternate embodiment, the networked computer includes a database containing records corresponding to each one of a plurality of handheld analyte monitoring devices. Each database record identifies a plurality of messages personalized to a user associated with a particular handheld analyte monitoring device. Message sent back to the handheld analyte monitoring device is selected from the plurality of messages using the script executed by the rules engine.
• In yet another alternate embodiment, the monitoring system of the invention can be used to monitor other medical information including, for example, physiologic parameters such as heart rate, blood oxygen saturation, blood pressure, respiration rate, blood pressure, electrocardiographic (ECG) information including ECG morphology using a sensor in communication with an implantable cardioverter defibrillator, body temperature, and the like. Sensors for such physiologic parameters are known in the art and are commercially available.
• Various aspects of the present invention can be implemented by software, firmware, hardware, or a combination thereof.FIG. 12 illustrates anexample computer system1200 in which the embodiments, or portions thereof, can be implemented as computer-readable code. For example,networked computer112 carrying outmethod1000 ofFIG. 10 can be implemented insystem1200. Various embodiments of the invention are described in terms of thisexample computer system1200. As another example,remote computer114 can be implemented in a computer system such assystem1200.
• Computer system1200 includes one or more processors, such asprocessor1204. Processor can be a special purpose or a general purpose processor.Processor1204 is connected to a communication infrastructure1206 (for example, a bus or network).
• Computer system1200 also includes a main memory1208, preferably random access memory (RAM), and may also include asecondary memory1210.Secondary memory1210 may include, for example, a hard disk drive and/or a removable storage drive. Removable storage drive1214 may include a floppy disk drive, a magnetic tape drive, an optical disk drive, a flash memory, or the like. The removable storage drive1214 reads from and/or writes toremovable storage unit1218 in a well-known manner.Removable storage unit1218 may include a floppy disk, magnetic tape, optical disk, etc. which is read by and written to by removable storage drive1214. As will be appreciated by persons skilled in the relevant art(s),removable storage unit1218 includes a computer usable storage medium having stored therein computer software and/or data.
• In alternative implementations,secondary memory1210 may include other means for allowing computer programs or other instructions to be loaded intocomputer system1200. Such means may include, for example, aremovable storage unit1222 and aninterface1220. Examples of such means may include a program cartridge and cartridge interface (such as that found in video game devices), a removable memory chip (such as an EPROM, or PROM) and associated socket, and otherremovable storage units1222 andinterfaces1220 which allow software and data to be transferred from theremovable storage unit1222 tocomputer system1200.
• Computer system1200 also includes acommunications interface1224.Communications interface1224 allows software and data to be transferred betweencomputer system1200 and external devices.Communications interface1224 may include a modem, a network interface (such as an Ethernet card), a communications port, a PCMCIA slot and card, or the like. Software and data transferred viacommunications interface1224 are in the form of signals which may be electronic, electromagnetic, optical, or other signals capable of being received bycommunications interface1224. These signals are provided tocommunications interface1224 via acommunications path1226.Communications path1226 carries signals and may be implemented using wire or cable, fiber optics, a phone line, a cellular phone link, an RF link or other communications channels. For example,communications path1226 may correspond to communications link110 and/or communications link116. In this example,links110 and116 may be networks connected to the global Internet, andcommunications interface1224 may be a network card configured to receive TCP/IP-based communications from such networks.
• In this document, the term “computer readable storage medium” is used to generally refer to media such asremovable storage unit1218,removable storage unit1222, and a hard disk installed inhard disk drive1212. Computer readable storage medium can also refer to one or more memories, such as main memory1208 andsecondary memory1210, which can be memory semiconductors (e.g. DRAMs, etc.). These computer program products are means for providing software tocomputer system1200.
• Computer programs (also called computer control logic) are stored in main memory1208 and/orsecondary memory1210. Computer programs may also be received viacommunications interface1224. Such computer programs, when executed, enablecomputer system1200 to implement the embodiments as discussed herein. In particular, the computer programs, when executed, enableprocessor1204 to implement the processes of embodiments of the present invention, such as the steps in the methods discussed above. Accordingly, such computer programs represent controllers of thecomputer system1200. Where embodiments are implemented using software, the software may be stored in a computer program product and loaded intocomputer system1200 using removable storage drive1214,interface1220, orhard drive1212.
• Embodiments may be directed to computer products comprising software stored on any computer usable medium. Such software, when executed in one or more data processing device, causes a data processing device(s) to operate as described herein.
• Embodiments may be implemented in hardware, software, firmware, or a combination thereof. Embodiments may be implemented via a set of programs running in parallel on multiple machines.
• It is to be appreciated that the Detailed Description section, and not the Summary and Abstract sections, is intended to be used to interpret the claims. The Summary and Abstract sections may set forth one or more but not all exemplary embodiments of the present invention as contemplated by the inventor(s), and thus, are not intended to limit the present invention and the appended claims in any way.
• The present invention has been described above with the aid of functional building blocks illustrating the implementation of specified functions and relationships thereof. The boundaries of these functional building blocks have been arbitrarily defined herein for the convenience of the description. Alternate boundaries can be defined so long as the specified functions and relationships thereof are appropriately performed.
• The foregoing description of the specific embodiments will so fully reveal the general nature of the invention that others can, by applying knowledge within the skill of the art, readily modify and/or adapt for various applications such specific embodiments, without undue experimentation, without departing from the general concept of the present invention. Therefore, such adaptations and modifications are intended to be within the meaning and range of equivalents of the disclosed embodiments, based on the teaching and guidance presented herein. It is to be understood that the phraseology or terminology herein is for the purpose of description and not of limitation, such that the terminology or phraseology of the present specification is to be interpreted by the skilled artisan in light of the teachings and guidance.
• The breadth and scope of the present invention should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the following claims and their equivalents.

Claims (41)

What is claimed is:

1. A blood glucose monitoring system comprising:

a handheld blood glucose monitoring device having

a glucose sensing subsystem configured to measure a blood glucose level in a blood sample, and

a radio transceiver subsystem configured to receive blood glucose measurements from the glucose sensing subsystem and to transmit the blood glucose measurements over a wireless communications link;

a networked computer configured to receive the transmitted blood glucose measurements; and

a rules engine running on the networked computer to execute at least one script in response to a received blood glucose measurement and produce a message to be sent back to the handheld blood glucose monitoring device.

2. The system ofclaim 1, wherein said networked computer further comprises a database containing records corresponding to each one of a plurality of handheld blood glucose monitoring devices.

3. The system ofclaim 2, wherein each database record identifies a plurality of messages personalized to a user associated with a particular handheld blood glucose monitoring device, and wherein the message sent back to the handheld blood glucose monitoring device is selected from the plurality of messages using the script executed by the rules engine.

4. The system ofclaim 1, wherein the handheld blood glucose monitoring device further comprises a display to display the blood glucose level from the glucose sensing subsystem.

5. The system ofclaim 1, wherein the handheld blood glucose monitoring device further comprises a user interface for receiving input from a user for control of the glucose sensing subsystem and the radio transceiver subsystem.

6. The system of5, wherein the user interface comprises buttons along a side of the handheld blood glucose monitoring device.

7. The system of5, wherein the user interface and the display comprise a touch-sensitive screen.

8. The system of5, wherein the radio transceiver subsystem is further configured to transmit over a wireless communications network a response entered via the user interface.

9. The system of8, wherein the networked computer is configured to receive the response.

10. A blood glucose monitoring system comprising a first computer configured to:

communicate via a network;

receive, via the network, blood glucose measurements from a plurality of remotely-located blood glucose monitoring devices;

store each measurement from a particular device in a record, corresponding to the particular device, of a database;

execute at least one script, in response to receiving the measurement from the particular device, to produce a message to be sent back to the particular device; and

transmit, via the network, the message to the particular device.

11. The system ofclaim 10, wherein the first computer tracks a number of measurements made by the particular device and, when the number reaches a predetermined value, the message includes information related to ordering replacement blood glucose measuring strips for use with the particular device.

12. The system ofclaim 10, wherein the message includes an offer related to ordering any of replacement blood glucose measurement strips, related supplies, and other merchandise.

13. The system ofclaim 10, wherein the first computer compares the particular measurement to a threshold and the message includes information related to the comparison.

14. The system ofclaim 10, wherein the first computer is further configured to produce statistical data related to the measurements from the particular device or a particular plurality of devices.

15. The system ofclaim 14, wherein the first computer is further configured to transmit the statistical data to the particular device or to a remote computer.

16. The system ofclaim 10, further comprising a remote computer in communication with the first computer via the network, wherein the remote computer includes a script editor to edit the at least one script associated with the particular device.

17. The system ofclaim 16, wherein the script editor is configured to edit the at least one script by selecting the at least one script from a plurality of scripts.

18. The system of16, wherein the script editor is further configured to allow creation of a personalized message for transmission to the particular device via the first computer.

19. A handheld blood glucose monitoring device comprising:

a glucose sensing subsystem configured to measure a blood glucose level in a blood sample;

a radio transceiver subsystem configured to receive blood glucose measurements from the glucose sensing subsystem, to transmit the blood glucose measurements over a wireless communications link, and to receive over the wireless communications link a message returned to the handheld device in response to the transmitted blood glucose measurement; and

a display to display blood glucose measurements from the glucose sensing subsystem and to display the message received from the radio transceiver subsystem.

20. The device ofclaim 19, wherein the display comprises a graphical indication of a comparison between the measured blood glucose level and a target blood glucose level.

21. The device ofclaim 19, further comprising a user interface for receiving input from a user for control of the glucose sensing subsystem and the radio transceiver subsystem.

22. The device of21, wherein the user interface comprises a plurality of buttons on the handheld blood glucose monitoring device.

23. The device of21, wherein the user interface and the display comprise a touch-sensitive display.

24. The device ofclaim 19, wherein the radio transceiver subsystem comprises a GPRS radio.

25. The device ofclaim 19, wherein the radio transceiver subsystem encrypts the transmitted blood glucose measurements prior to transmission.

26. The device ofclaim 25, wherein the radio transceiver subsystem encrypts the transmitted blood glucose measurements using two-factor authentication.

27. The device ofclaim 25, wherein the radio transceiver subsystem encrypts the transmitted blood glucose measurements using 128-bit encryption.

28. The device ofclaim 19, further comprising a single microcontroller configured to control both the glucose sensing subsystem and the radio transceiver subsystem.

29. A method for monitoring blood glucose levels of a plurality of patients, comprising:

receiving, at a computer via a wireless network, blood glucose measurements from a plurality of blood glucose monitoring devices, each device associated with a respective one of the plurality of patients;

storing each measurement from each device in a corresponding record of a database, wherein each record corresponds to a respective device;

executing, for each received measurement, at least one script associated with the respective record to produce a message to be sent back to the respective device; and

transmitting the respective message to the respective device.

30. The method ofclaim 29, further comprising tracking a number of measurements received from a respective device and, when the number reaches a predetermined value, transmitting to the respective device a message including information related to ordering replacement blood glucose measuring strips for use with the respective device.

31. The method ofclaim 29, wherein the message includes an offer related to ordering any of replacement blood glucose measurement strips, related supplies, and other merchandise.

32. The method ofclaim 29, further comprising calculating statistical data related to the measurements from the respective device or a particular plurality of devices.

33. The method ofclaim 32, further comprising transmitting the statistical data to the respective device or to a second computer.

34. The method ofclaim 29, further comprising allowing editing of the at least one script associated with a respective device.

35. An analyte monitoring system comprising:

a handheld analyte monitoring device having

an analyte sensing subsystem configured to measure an analyte from a patient, and

a radio transceiver subsystem configured to receive analyte measurements from the analyte sensing subsystem and to transmit the analyte measurements over a wireless communications link;

a networked computer configured to receive the transmitted analyte measurements; and

a rules engine running on the networked computer to execute at least one script in response to a received analyte measurement and produce a message to be sent back to the handheld analyte monitoring device.

36. The system ofclaim 35, wherein said networked computer further comprises a database containing records corresponding to each one of a plurality of handheld analyte monitoring devices.

37. The system ofclaim 36, wherein each database record identifies a plurality of messages personalized to a user associated with a particular handheld analyte monitoring device, and wherein the message sent back to the handheld analyte monitoring device is selected from the plurality of messages using the script executed by the rules engine.

38. The system ofclaim 35, wherein the handheld analyte monitoring device further comprises a display to display the analyte level from the analyte sensing subsystem.

39. The system ofclaim 35, wherein the handheld analyte monitoring device further comprises a user interface for receiving input from a user for control of the analyte sensing subsystem and the radio transceiver subsystem.

40. The method ofclaim 35, further comprising tracking a number of measurements received from a respective device and, when the number reaches a predetermined value, transmitting to the respective device a message including information related to ordering replacement analyte measuring strips or other supplies for use with the respective device. Alternatively, the user may be prompted to order other merchandise related to his/her needs.

41. The method ofclaim 40, wherein the particular device responds to the first computer to confirm the order for replacement measuring strips.

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