The healthcare landscape is rapidly changing. Chronic illness has become the true burden on the healthcare system — accounting for over 75 percent of national health expenditures. To combat this systemic strain, the treatment of chronic and long-term care is being transferred out of hospitals and clinics and into the home. More than 65 million people provide care for a chronically ill, disabled, or aged family member or friend. This movement from the centralized to remote care of individuals is transforming the home environment into what we’ve termed a “Hospital of One.” This shift has major implications for patients, caregivers, and the industries who serve them.
As part of the fallout of this change, medical devices once only used in hospital settings are being thrust into the inexperienced hands of consumers. There’s an urgent need for these medical (or POC) devices to be functional for the everyday person: less clinical, more approachable, and easier to operate.
In our recent work with Respironics, a leader in the home respiratory care market, we faced this exact challenge: taking an intimidating piece of medical equipment–a Continuous Positive Airway Pressure (CPAP) machine–and making it feel approachable and usable for sleep apnea sufferers. We realized quickly that the use of a CPAP comes with much stigma. Patients are required to wear a cumbersome mask and tube system that simulates breathing during the night. As a result, the treatment helps deliver a regenerating, restful sleep. For our innovative work on this project—creating the REMstar CPAP Base Station—we won an MDEA award.
In addition to our work with Respironics, we’ve partnered with top healthcare companies in creating devices that meet the needs of this new consumer—working with clients such as Samsung, where we developed a set of digital thermometers that eased the task of taking a sick child’s temperature, and Insulet, where we created the first wearable insulin pump that attaches directly to the user’s skin. We want to share our insights into this growing area of design. Here are five key principles we use to design solutions that make long-term medical conditions a smaller part of life.
1. Understand the context of use
As designers, it’s essential for us to understand when, where, and how the product will be used in order to design a device that will integrate into the patient’s life in a way that makes sense and is as supportive an unobtrusive as possible.
Most real-life interactions with the CPAP machine occur at night when the users are awakened from a sound sleep. They often make adjustments in the dark, without using glasses. Users don’t want to turn the light on to use the machine because they don’t want to disturb their partner more than necessary. As such, the interface had to facilitate people making adjustments to the device with their “eyes closed.” Uniquely textured buttons with variable elevations allow users to identify and adjust the correct buttons by touch alone. The primary control knob is large and prominently located so that it can be easily found, and detents allow the user to “count off” the level of adjustment by feel.
In the recent work we did for Gulp, a pill-taking assistant for kids who need to take medication several times a day, we addressed a different set of constraints. Many schools have banned drink containers and water bottles on school grounds, forcing kids who need to take medication during the school day to ask permission to leave the room for every dose. Gulp discretely holds a child’s medication and has a reservoir for their favorite liquid. With a simple tip and squeeze, kids can easily and quickly swig down their medication without having to leave the classroom.
2. Simplify the interface
Many people are inexperienced with electronic gadgets and feel anxious using a new device. Addressing these concerns and making the interface of POC devices easy to use—and thereby lessening the fear and anxiety—is key. It will not only lead to more compliance and adherence in treatment, it makes for a more positive user experience.
With the CPAP project, we specifically designed the interface for ease of use for their primary audience of older adults with a much lower technology comfort level. When CPAP treatment begins, a clinician adjusts a set of pre-programmed variables. Most patients will never interact with those functions during day-to-day treatment. Clinicians program the individual patient setting and then hide the display and setup interface under a hinged door, leaving only the minimal patient adjustment controls visible. This removes any sort of patient anxiety about accidentally changing settings or altering their prescribed treatment.
Having received negative consumer feedback from its pregnancy test prototype, Selfcare enlisted the help of Continuum to create a better test kit quickly to meet the scheduled launch date. Emotions run high for users of this product, so it’s essential to ease their minds—making the design simple, clear, and easy to use.
The existing design provided no indication of how to hold the product. Additionally, the shape of the design was mechanical and masculine—in sharp contrast to the intended user. Utilizing learnings from user testing, Continuum designed a product that is more feminine and more instructive in its aesthetic, with grip details that greatly increase its usability.
It’s cases like these that show how understanding your user and what they need emotionally and physically from a device will lead to a more successful product.
3. Reduce stigma
No one wants to broadcast to the world that they’re sick. Device designers must understand the importance of making the patient’s experience with their disease a smaller part of their life.
One of the main impediments to compliant usage of a CPAP: The patient’s anxiety about revealing their condition to others by prominently displaying a large piece of intimidating medical equipment on their bedside. To address this issue, the design team developed a device that had appealing, peaceful, and calming design cues. The design language of the machine mimicked high-end home electronics by using softly curved surfaces and a rich-yet-neutral color palette. As a measure of our success, a study published in the June 2005 issue of Chest showed that patients using a REMstar Pro used their therapy an average of 1.7 hours longer per night than patients on the older CPAP after three months. And the difference in adherence widened over time.
Aware of the burden diabetes puts on those with the condition, Insulet wanted to create a product to minimize the physical and emotional difficulty of regular insulin administration. Continuum designed the new, lightweight OmniPod. A wireless, tube-free, hands-free device, the OmniPod revolutionized continuous insulin therapy by making diabetes less of a burden.
Giving Gulp a kid-friendly aesthetic was one of the most important goals for the concept. As a tool to help kids escape the stigma of taking medication in public, it was essential that it blend in with the normal things kids carry to school. A playful color palette makes Gulp feel fun and not at all intimidating.
4. Life enhancement vs. life support
People don’t want to be made to feel sicker than they actually are. Often POC devices look daunting, scary, and do nothing to make the patient or their families feel better about their condition.
One of our main goals when designing medical equipment intended to be used by the patient or a family caregiver is to communicate an appropriate level of seriousness, while removing the feel of an intimidating “medical” device. For example, when in the hospital, patients expect medical equipment to look professional and serious. But when using a device at home, a user doesn’t want it to broadcast sickness.
There is a subjective element to sickness. People come at disease with different perspectives. For example, a nurse is there to keep her patient healthy and safe. But for a family or a patient taking care of himself at home, caring for the disease becomes an emotional act. Patients need positive reinforcement of their condition. If they feel scared of their illness, it has an effect on their recovery. Recently we had a doctor in Spain describe enteral feeding systems as looking like ‘the end of life’, a message that is in conflict with the projected outcome for many of these patients. As a result of this feeling, he chose not to have his patients connected to the system during visiting hours as he was afraid it would have a negative impact of the patient’s family.
5. Design Integration
So what does this all mean for healthcare companies, patients, and a new generation of family caregivers? As the healthcare landscape rapidly changes—transferring care out of the hospital and pushing more and more of the burden onto patients and their family caregivers—we continue to see the transformation of the home environment into what we’ve termed a “Hospital of One.”
Many healthcare companies are still producing devices to be operated by nurses and physicians in a traditional clinical environment. Healthcare companies and their designers will need to redefine the definition of their critical stakeholders and their true needs. Our environment focus may no longer be infection control but keeping devices away from inquisitive children. The caregiver focus will not be about charting Mrs. Smith’s vital signs but rubbing water on her lips because you worry that your wife is dehydrated because it’s warm today and with her MS she can’t tell you.
We will need to determine how we design critical medical devices for the home that will integrate on all levels of the home environment. It will not simply be about making dumbed-down versions of what currently exists. Devices will need to be clear to use for a non-healthcare professional. We will need to use the power of emotive design to deliver optimism. Many devices look like the end-of-life; but these patients aren’t necessarily on their death bed anymore. Patients at home are meant to get better and recover.
