In 1844, the Irish physician Francis Rynd invented the first recorded subcutaneous syringe to treat neuralgia. He expected it to be superior to the traditional method of oral ingestion and his assumptions were confirmed. His invention was so effective that it earned him praise from Florence Nightingale. “Nothing did me any good but a curious little newfangled operation of putting opium under the skin, which relieved one for 24 hours,” said Nightingale.

Despite the success of the syringe, it took a long time for future developments to occur. Nine years later the Scottish physician Alexander Wood, the inventor of the hypodermic needle, added a plunger to the device. It was 160 years before the next large shift occurred.

In 2014, David Swann won the World Design Impact Prize for the creation of a syringe that changed colour after use, inhibiting the spread of disease. This invention was groundbreaking, and within two years, a company had created an injector that informed patients about their dosage schedules via near-field communicative tags, pocket-held computers and online video tutorials.

Around the same time, Gautam and Kanupriya Goel, a husband and wife team based in the US, pioneered selfexpiring packaging. This was designed to help those with sight problems, such as the elderly. The concept entails two layers of ink that hold different information. The first contains details about the product, while the second – an invisible ink – reveals the product’s expiration date, which only becomes visible as the date approaches.

Although such inventions were novel at the time, they pale into insignificance with the developments of today. With near-field communication (NFC), radio-frequency identity tags (RFID), sensors, Bluetooth and smartphones, users are now able to interact with a product via its technology-heavy packaging. We are a long way from the syringe of 1844.

Although smart packaging is the most commonly used term, active or intelligent packaging are also sometimes used. These tend to be used in reference to the same concept: packaging systems used typically for food, beverage or pharmaceutical products that have been enhanced to extend shelf life, monitor freshness, provide visual information about the product inside the package, improve safety and offer convenience.

Although these terms are frequently used interchangeably, they are distinct. Active packaging mainly refers to features that enhance the protection function of a packaging system. On the other hand, intelligent or smart packaging largely relates to utility and communication, the two other packaging functions.

Javier de la Fuente knows a lot about packaging. He has a masters and a doctorate in packaging from Michigan State University, has published over 30 books, chapters and peer-reviewed articles relating to packaging, and is the co-founder and partner of a consultancy that specialises in packaging.

“Asking, ‘Are we going to be able to compost or recycle packages with smart packaging features with our current infrastructure for processing packaging waste?’ is key.”

For De la Fuente, the big advantage of smart packaging is value. “Smart packaging features can provide value to different stakeholders of the packaging value chain,” he says. “For example, extending shelf life of a product, making product use safer, more convenient or more effective.”

There are a number of different smart packaging technologies that have been developed, which can not only change supply chain operations but also change the way that healthcare professionals and patients interact with medical devices. For example, QR codes that are used to interact with smartphones. Scanning a code tends to launch a web page with information about the product. This can help to boost health literacy levels among patients.

A product’s digital twin can also store relevant information without any space limitations, which can easily be accessed via a smartphone app. This might include additional advice from clinicians about how to use the device, for example. It could also provide an interface for healthcare professionals to remotely update the device or collect data about the side effects of produce efficacy from patients.

Thermochromic inks are another key development. These are substances that react to changes in temperature and are either reversible or permanent. Thermochromic inks can be used to print temperature indicators on packages.

Two more commonly known advances are smart labels and smart sensors. Smart labels use different technologies, such RFID or NFC. These can be used to identify and track items without physical contact and without a line of sight. RFID achieves this by using electromagnetic fields. These types of labels can be used for anti-counterfeiting applications or to indicate whether or not a product has been used.

Smart sensors are circuits created with printed electronics that can detect changes in humidity, light and temperature. Traditional printing methods are used to print these with special conductive inks.

These technologies are certainly exciting but do need to be implemented strategically in order to be effective. “In my opinion, it is key to work in cross-disciplinary teams,” says De la Fuente. “This is obviously dependent on the application being developed, but it could include industrial designers, graphic designers, packaging engineers, marketers, electrical engineers, material engineers and so on.”

This collaborative approach offers a number of benefits. “Diverse teams tend to focus on feasible and useful solutions quicker,” says De la Fuente. “Conflicting views help to direct the project towards viable solutions.”

Keep the patient in mind

Using a patient-centred design process is also key when working on smart packaging technologies. “It is critical to understand very well the problems end users are facing,” says De la Fuente. “This applies not only to the development of products for end consumers, but for any application that involves interactions with humans.”

As with any developments within the medical device industry, regulation is a central consideration, although this is not always straightforward. “The developing team needs to be very familiar with the regulations affecting their particular application,” explains De la Fuente. “Smart packaging applications are very dissimilar and so are the regulations that control them. It takes time to get familiar with the set of rules that affect a given application or particular product.”

There are also a number of other challenges to navigate in this field, such as sustainability. “Asking ‘are we going to be able to compost or recycle packages with smart packaging features with our current infrastructure for processing packaging waste?’ is key,” says De la Fuente.

Technical issues can be tricky. For example, RFID tags do not work well at the item level to replace barcodes. In addition, there are also privacy concerns, such as smart tags being read without consumer’s consent. The relatively high cost of smart packaging can also be prohibitive.

Although De la Fuente is reluctant to make specific predictions, he offers a number of potential future scenarios for smart packaging. “On the technological side of things, our present is marked by increasing computing power, connectivity, big data, artificial intelligence, instant communication new materials,” says De la Fuente. “For the most prosperous parts of world societies, we are probably going to see computing power increasing to levels that we cannot imagine. We will be able to process colossal amounts of data using algorithms with artificial intelligence, and physical objects might be able to communicate with other physical objects.”

However, not all future scenarios are envisioned quite as optimistically. “On the social side of things, we are facing massive environmental concerns, ageing societies in developed countries, societies with high indices of diabetes and obesity, healthcare associated infections, increased antibiotic resistance, increasing inequality in almost every single society and shifting populations,” says De la Fuente “This is quite a cocktail. If these trends continue, we are going to have an extremely stressed world.”

“In my opinion, it is key to work in cross-disciplinary teams. This is obviously dependent on the application being developed but could include industrial designers, graphic designers, packaging engineers, marketers, electrical engineers, material engineers and so on.”

For the less-prosperous parts of societies, many of these potential future advances might be considered extravagances. “Smart packaging features contributing to mitigate the negative results of the general trends might be more valued,” says De la Fuente. “For example, packages that would extend shelf life and provide healthcare benefits at very low cost.”

Nevertheless, smart packaging is clearly here to stay. “Medical products for ageing societies will need lots of smart packaging features to solve trivial issues, such as patient compliance, or more complicated ones such as in-home healthcare,” says De la Fuente. “Connectivity with smartphones would be key.”

It is clear that smart packaging provides a huge number of opportunities for the industry. Aside from adherence to regulations and optimising logistics processes, there is the potential to dramatically improve the user experience, helping to bridge the gap between healthcare professionals and patients. It will be exciting to see the developments that occur, inside and outside the medical device industry, over the next few years.