Patient experience design and the future medical health device landscape

Dr Rafael Gomez

The medical health device industry is on the precipice of fundamentally changing our lives. With the rise of portable, wearable and implantable medical devices we are entering an era of previously unimagined level of information about our health and wellbeing. By their very nature the products that we carry with us are intimate, with the capacity to track, record, manage, diagnose and respond to our body and personal context – radically changing the way we manage our personal health. As technology progresses we will see devices shift from operating externally to our bodies and ultimately merge internally as implantable technologies. At that point the experience transforms completely and we enter an era where products themselves have the power to change not only the patient experience but also ultimately the human condition. In this article, I will review the trends that have emerged beyond the current medical health device landscape.

This presents an opportunity for design research and experience design: how will trends in medical health devices impact the nature of health and the patient experience? 

It is important to understand this new landscape for more effective design strategies in the medical health device design field. Through the analysis, presented devices are categorised along three dimensions, namely: form (dedicated or add-on), purpose (monitor, nudge, advanced diagnostic) and mode of use (external, wearable, internal), with mode of use being a driving factor for significant change. Considerations of the potential impacts on the nature of healthcare and patient experience are discussed through the lens of experience design. By better understanding medical health devices and impacts of future trends from an experience design perspective, researchers, designers and technology experts can contribute in a more meaningful way to this potential future that can ultimately raise the quality of life for patients.

The Rise of Medical Health Devices

Portable and wearable devices are gaining traction in applications where they are facilitating the management of various conditions as well as personal health monitoring (e.g. fitness trackers). Ghaswalla from appaloud.com predicts the market will grow somewhere between $30-$50 billion a year in the next 3-5 years. Apple is betting on the growth of this market with the release of the Apple Watch, while Google has done the same with Google Glass. Other players include Samsung with the Gear range of devices, Fitbit, Jawbone’s Up and Nike’s Fuelband. Recently, Rachel Arthur from Forbes reported that wearables also include fashion garments and apparel that utilise smart materials, high-tech fibres and textiles that can transfer and utilise digital data of the wearer or the immediate environment.

Medical health devices will play a more crucial role as they have the capacity to reduce economic pressure on the healthcare system, curtail unhealthy habits, increase likelihood of improved lifestyle choices and enhance the experience of health management. Furthermore, they have the potential to enhance the experience and overall quality of life for patients with chronic conditions. These types of devices not only permit ongoing, continuous and unobtrusive monitoring of physiological conditions, they can also provide more realistic indications of health status and information that is otherwise inaccessible.

Experience Design

For over a decade the design field has seen an emerging interest in what has been termed as experience design. Hassenzhal, a leading researcher, asserts that experience design attempts to capture a more comprehensive understanding of the overall human-product interaction.

Experience design asserts design not to be about products anymore but about the experiences they deliver… meaning and emotion (become) the prime design objective

Although users are concerned about practical issues, they often care more about how products mediate experiences in everyday life. Experience encompasses: emotions, attachment, context and relationship with the product over the course of time.

The experience design approach is relevant for medical health devices as emotions have a significant role to play in how people feel about themselves and about their health; actively promoting or hindering health outcomes. Positive experiences can actively bolster the immune system and take on a crucial role in patient therapy. If devices fail to take into account patient experience they can lead to poor health practices and reduced quality of life. Fairbanks and Wears (2008) describe two cases in which limited consideration of user experience led to dangerous and hazardous results. In the first situation a medical team working on a cardiac arrest patient inadvertently delivered an electric shock leaving the patient with profound neurological injuries. The second case was a simulation where physicians were observed powering down a defibrillator when they intended to deliver a shock instead. Both cases appear like simple design flaws but also reveal a deeper issue about user experience. These devices failed because they were not designed to match the needs, cognitive processes, and context of use. It is important to consider the experiential and emotional aspects of the users involved in these examples. In both cases stress and anxiety are experiential aspects that may have also contributed to incorrect use and errors with the device.

Current and Future Trends

Medical health devices enable people to be acutely aware of their health and wellbeing virtually at any time in any context. From an experience design perspective, they can be considered as mediators between the user and a positive health outcome.  

The trend for smaller, more powerful and sophisticated devices with internet capabilities are transforming the health care industry and spurring the development of devices for health management, tracking, monitoring, diagnosis, treatment and measuring of various health related data. These will no longer just be portable but soon the idea of always-wearable devices could seem ordinary. In the not too distant future, we could experience devices embedded into our bodies to track, diagnose and respond automatically and without our knowledge to physical and physiological conditions. We can classify this transformation along three interconnected dimensions: form (dedicated or add-on), purpose (monitor, nudge and advanced diagnostic) and mode of use (external, wearable, internal). By classifying the existing landscape from this novel perspective, several emerging trends in the medical health device landscape can be identified and aspects relating to the potential impact on the nature of healthcare and the patient experience can be discussed.

Form

The first trend relates to the changing forms of medical health devices. Here, form is broken into two types: dedicated devices for specific medical needs and add-on to existing devices. Numerous manufacturers are developing specific devices for various conditions such as diabetes and heart disease through to health and fitness devices. This area of the medical field is evolving rapidly but is also being absorbed in some cases by the development of add-on technologies. One type of add-on device that is growing rapidly is health related apps on mobile phones. There are apps that target almost any conceivable area of health including chronic conditions, telemedicine, remote monitoring, data capture, electronic records, e-prescribing, and health and fitness Services like WebMD are another form of add-on that have become available to patients on mobile devices, making self-diagnosis easily accessible to the billions who use mobile phones. Peripheral products that attach to existing mobile devices and provide new functionality are another type of add-on technology. Examples include blood glucose peripherals and an eye-testing device that attach to mobile phones.

Purpose

The second trend is classified according to the purpose these devices serve including monitoring, nudging and advanced diagnostics. Devices used for monitoring medical information have been around for some time with electrocardiogram (ECG) and electroencephalogram (EEG) being some of the first portable devices available. The AMON (advanced care and alert portable telemedical monitor) consists of a monitoring and alert system for high-risk cardiac and respiratory patients. Recently monitoring devices have moved into the health and fitness area that can log data about people’s exercise routines, habits and patterns with Fitbit and Jawbone being examples of popular devices in this area.

Beyond monitoring and data logging, devices have moved into what has been termed as ‘nudging’ or persuasive functions. These refer to the ways in which a device motivates or prompts users to perform activities that encourage them away from potentially harmful choices and nudges them towards healthier options. For instance, UbiFit transforms the background wallpaper on a mobile phone into a garden through physical movement, encouraging users to be physically active to keep the garden nourished. Another simple example is the Vito television remote control that offers viewers alternatives to watching TV including viewing to-do lists and playing physical games.

A third group of devices are defined as advanced diagnostic. These support complex healthcare applications and enable continuous provision of medical needs by monitoring the patient and environment and respond accordingly. Some of the vitals signs these devices can monitor include electromyogram (EMG), electrocardiogram (ECG), activity, mobility, falls, respiratory rate, heart rhythm, blood glucose levels, oxygen saturation, body or skin temperature and galvanic skin response. The Cardionet wearable system monitors patient heart rate, ECG and other data to help physicians diagnose and support patients suffering from arrhythmias. Likewise, ingestible medical devices that offer non-invasive alternatives to traditional endoscopy or surgery for diagnosis and treatment of gastrointestinal disorders offer further example of advanced diagnostic devices.

Mode of Use

The ways these devices are utilised has evolved from devices that are external to ones that are worn on the body to more recent devices that function in our bodies. The initial wave were external to the body (with a few exceptions). As microelectronics and textile technology evolved wearable devices became common. Wearables are similar to portable but the term suggests that the support environment is either the human body or a piece of clothing. In this way wearable devices are closer in proximity to the body and have a different relationship to the person.

Current developments include implantable devices, which significantly alter the patient-device relationship. The technology required for more modern implantable devices is also changing and impacting the user experience at a fundamental level. These devices, working at the nano-scale in some cases, are used for a variety of therapeutic or life-saving functions ranging from drug infusion and cardiac pacing to direct neurostimulation. Implantable devices can automatically and directly alter a patient physically, physiologically and in many cases without any patient interaction. It is this dimension that is interesting to discuss in terms of the health experience. This presents designers with a unique challenge because as devices move from external to wearable to internal, the ways in which we relate and interact with devices changes significantly. Implantable devices have the capacity to modify the patient’s condition without the patient even knowing. This is a drastic change in user-product interaction that requires a new way of defining and evaluating the health experience.

Form changes and transformations in purpose are relevant to outline but it is the change in mode of use that will perhaps have the biggest impact on the nature of healthcare and the patient experience. As dedicated and add-on devices begin to be implanted in our bodies performing monitoring, nudging and advanced diagnostic functions without patient interaction or awareness, it is crucial to begin to explore opportunities, questions and the role that design plays in this future scenario.

The Role of Experience Design in the Future Medical Health Device Landscape

When personal medical devices evolve beyond wearable to implantable, and their mode of use changes from conscious to sub-conscious to no awareness of device interaction, patients will enter an era in which the very products themselves have the power to change the human condition. Implantable devices will have the capacity to substantially affect physiology, behaviour, and emotions impacting general health and wellbeing.

By addressing how people relate and interact with current and future medical health devices, they can be better designed to suit the needs, requirements, wants and overall demands of patients within the healthcare system. Appropriately designed devices can permit patients to make informed decisions about their health and chronic conditions, take responsibility for their personal health management, motivate patients to make the right choice at the right time, reduce the stress of managing chronic health, enhance experience and improve the overall quality of life for patients.

From a design perspective there is a research opportunity to explore and better understand the ways these devices facilitate experiences in everyday life. Understanding the potential trends and the way they impact the nature of healthcare and the patient experience is a first step towards initiating a dialogue that will lead to effective design strategies in the future medical health device landscape.

This article has been adapted from published paper Gomez, R., & Harrison, A. (2014). Beyond Wearables: Experiences and Trends in Design of Portable Medical Devices. In Design, User Experience, and Usability. User Experience Design Practice (pp. 261-272). Springer International Publishing.

Dr Rafael Gomez holds a PhD in design, with an expertise in emotional experience, and is the design and emotion research leader for the People and System Lab at Queensland University of Technology (QUT) in Brisbane, Australia. He is a prominent researcher in the field publishing and frequently presenting nationally and internationally. His research has uncovered unique findings regarding peoples emotional experience with interactive devices and he has since developed frameworks to better understand emotional experience with portable and wearable health devices as well as automotive interfaces.

In addition, Dr Gomez has over 15 years industry experience as a designer for small, medium and large enterprises in aviation, construction, health, medical, government and consumer electronics industries. He is founder and director of Propaganda Mill, a multidisciplinary design company working across product design, branding, graphics, high-end visualisation and projection graphics. He sits as a Council Member of the Design Institute of Australia Queensland Chapter, Founder and Chair of the Design and Emotion Society Australia Chapter and Committee Member for the 2015 IASDR International Design Conference.

Dr Gomez coordinates second year industrial design and established the Immersive Asia Study Tour for the Creative Industries Faculty. He has lectured, coordinated and written curriculum for various subjects including design visualisation, human-factors and ergonomics, usability and also led Work Integrated Learning for the School of Design. His extensive teaching experience has led to various awards including the recent nomination for the Inaugural David Gardiner Teacher of the Year Award QUT in 2014.