991019 e-pill Medication Dispensing Machine
A. Device Medication Management Capabilities
1. Identify the administration event(s) measured by this device (Choose any)
a. Administration acknowledgement by patient: YES
b. Drug absence as administration event
c. Other (explain)
2. Identify the mode of administration for this device (Choose one)
a. Administers individual drugs (e.g., one at a time)
b. Administers collection of drugs (e.g., cup of drugs): YES
3. Are daily scheduled medications supported? YES
4. Are PRN (“as needed”) medications supported? NO (Y/N)
5. Is early dose dispensing supported? YES
6. Are non-pill medications supported? NO (Y/N)
7. Are OTC medications supported? YES
(Y/N)
8. Are ODT (orally disintegrating tablet) medications (and related packaging) supported? YES
(Y/N)
9. Are medications stored separately or in contact with each other? In Contact (Separate / In Contact)
10. Are dispense containers re-used with other medications? (Y/N)
11. Are light sensitive medication protections provided? (Y/N)
12. Are reminders for other medications (outside of device) supported? (Y/N)
13. Are special instructions for medications supported (e.g., take with food)? (Y/N)
14. If special administration instructions for disease states are supported, which disease states are supported? (List)
15. What is the turnaround time for device changes (e.g., reprogramming) to manage medication dosage changes? (in Hours)
16. What is the maximum number of loadable administrations? (Count)
17. What is the maximum number of allowed administrations per day? (Count)
18. What is the maximum number of medications administered per administration event? (Count)
19. What is the maximum number of patients supported per device? (Count)
20. Who establishes the administration schedule for the device? (Patient, Caregiver, Pharmacist, Company)
21. Who do you recommend for loading medications into the device? (Patient, Caregiver, Pharmacy, Other)
22. What does a patient do to receive a medication from the device (e.g., push button, turn cap, other-describe)?
23. Please provide information regarding features offered by the device and service support for seniors and persons with disabilities.
B. Device Patient Alerts
1. What type of alert is provided for a standard administration event? (Visual, Sound, Voice, Other – describe)
2. Is there an Interactive Voice Response (IVR) for instructions? (Y/N)
3. Alerts are provided in which languages? (English, Spanish, Other Languages – List each)
4. Device labels are provided in which languages? (English, Spanish, Other Languages – List each)
5. Is there a refill alert? (Y/N)
6. What is the basis for a refill alert? (Actual Inventory, Forecasted Inventory, Patient Action, Date, Other – explain, N/A)
7. Does the device recognize incorrect medication loading? (Y/N)
8. Is there an alert on the device for a missed dispense? (Visual, Sound, Voice, Other – describe, None)
9. If missed dispense alert period is fixed or variable… indicate duration or range of durations until alert and re-alert (if applicable).
a. On first alert (duration or range)
b. On re-alert (duration or range)
10. Is there a missed dispense callback alert? (Y/N)
11. What is the period before a missed dispense callback alert? (Minutes)
12. Who is called first for a missed dispense callback alert? (Patient, Caregiver)
13. What is maximum number of caregivers alerted for missed dispense callback alert? (Count)
14. Is an alert provided in the event of a device failure? (Y/N)
15. Is an alert provided in the event of a power failure and/or power disconnect? (Y/N)
16. Who is alerted in the event of a device failure, power failure, or power disconnect? (Patient, Caregiver, Service Provider)
C. Device Adherence Reporting
1. Is there a medication adherence history report provided for the patient? (Y/N) (If Yes, provide an example)
2. Is a medication adherence history report provided for standard dispenses? (Y/N)
3. How often are medication adherence history reports available? (Monthly, Continuous, Other-explain)
4. Is a medication adherence history report provided for non-standard dispenses (e.g., Non-oral, PRN, OTC medications)? (Y/N)
5. Is a reporting web portal provided for viewing a medication adherence history report? (Y/N)
6. If the reporting web portal exists, are multiple authorized users allowed to access (e.g., patient, caregiver, doctor)? (Y/N)
7. Is medication adherence history data available for each device? (Y/N)
8. If medication adherence history data is available, provide a data specification and data transfer instructions/specification.
9. Are medication adherence history data safeguards HIPAA compliant? (Y/N)
D. Device Training & Support Characteristics
1. Who is training provided to? (Patient, Caregiver, Other – Describe)
2. What is the training scope? (Patient Use, Medication Loading, Troubleshooting)
3. Training is provided in which languages? (English, Spanish, Other Languages – List each)
4. Written instructional materials are provided to whom? (Patient, Caregiver)
5. Written instructional materials are available in which languages? (English, Spanish, Other Languages – List each)
6. What is the average duration of initial training? (in Minutes)
7. Follow-up training/guidance is provided to whom? (Patient, Caregiver, None)
8. What is the average duration of follow-up training / guidance (in Minutes)
9. What is the minimum skill level of your training staff? (licensed clinical, certified clinical, non-clinical)
10. Is device support for patients and their caregivers available 24/7/365? (Y/N)
11. Do you provide FAQ’s for patient and caregiver support? (Y/N)
(If Yes – please provide a listing of current FAQs)
12. What is the average response time between a request for training and the fulfillment of training for patients and caregivers? (in Hours)
13. How many training sessions are provided with each device without additional fees? (Count)
E. Device Physical Characteristics (assume 5 Medications if applicable)
1. What are the physical dimensions of the device(s)? (H, W, D)
2. What is the weight of the device(s)? (in pounds, unloaded)
3. What are the AC power requirements of the device(s)? (Volts; Amps)
4. Is battery operation supported? (Yes/No)
5. What is the duration of battery operation? (Hours)
6. Is power failure managed with battery backup? (Y/N)
7. Is data protected (saved) on power failure? (Y/N)
8. Can the device be manually operated to dispense medications? (Y/N)
9. What battery type(s) and how many of each is required?
10. Is a device theft deterrence mechanism provided (Y/N – describe if Yes)
11. Are the medications locked in the device? (Y/N)
12. Is this device an on-person portable device? (Y/N)
13. Is this device intended primarily for in-home use? (Y/N)
14. Is analog phone connectivity provided…
a. For alerts? (Y/N)
b. For dispense programming? (Y/N)
c. For dispense history downloads? (Y/N)
15. Is cellular phone connectivity provided...
a. For alerts? (Y/N)
b. For dispense programming? (Y/N)
c. For dispense history downloads? (Y/N)
16. Is WiFi connectivity provided...
a. For alerts? (Y/N)
b. For dispense programming? (Y/N)
c. For dispense history downloads? (Y/N)
17. How are caregiver alerts provided? (phone, email, SMS Text)
18. How are patient alerts provided? (on device, phone, email, SMS Text)
F. Device Inventory, Capacity, & References
1. List California Counties with currently installed devices (List)
2. List California Counties Not serviceable as of August 1, 2011 (List)
3. Who will deliver the device to the clients? (Installer / Shipper / Trainer/ Other)
4. Will this device and associated services be provided throughout California under an agreement with a single vendor? (Y/N)
5. Is this device an FDA approved medical device (e.g., Class II – Remote Medication Management System)? (Y/N)
6. What is the current installed device inventory as of August 1, 2011? (Count)
7. What is the current uninstalled device inventory as of August 1, 2011? (Count)
8. What is the current monthly device production capacity? (in Units/Month)
9. What is the current order/delivery cycle time? (in Days)
10. What is the average replacement cycle time for a device that requires replacement? (in Hours)
11. Please list contact information for up to three multi-device clients, with a preference for other Medicaid programs and California clients.
12. Please list references for published and unpublished studies involving your device.
13. Do you survey your users for their satisfaction with the device? (Y/N)
If Yes, please provide a copy of the most recent satisfaction survey.
14. Please provide a list of the 10 most prominent client complaints or reasons for returns device returns.
G. Device Cost Characteristics
1. What is the purchase price? (One-time & Recurring, such as recurring service or maintenance fees, if applicable)
2. What is the rental price? (Monthly)
3. Provide a list of what is included and what is excluded in a purchase agreement.
4. Provide a list of what is included and what is excluded in a rental agreement.
5. What is the minimum rental period?
6. What is the cost of medication holding or packaging supplies/materials (excluding medication costs) per single dose?
7. What is the cost of other supplies (List Each)? – (cost per single dose)
8. What is the monthly cost of communications connectivity?
9. What are the monthly costs of monitoring service(s)? (list each if tiered offerings)
10. What is the unit replacement cost if lost or stolen?
11. What are the average battery replacement costs per year?
12. What is the cost of additional patient or caregiver training sessions?
13. What is the estimated monthly cost of operation (5 meds x twice daily x 30 days) without medication costs?
14. What is the monthly cost of providing adherence history data to DHCS?