A diagnosis for a chronic illness often comes with a litany of instructions. In the absence of a cure for conditions like hypertension or diabetes, patients must manage their health by tracking symptoms and calibrating treatment plans.
But a growing number of at-home medical products take this record-keeping burden off patients by using intelligent sensors and autonomous computing to collect and transmit health data. These products include glucose monitors, electrocardiograms, scales, thermometers, fall detection sensors, sleep trackers, and nebulizers.
Toptal product designer Val Vasylenko, who has worked on devices for FitBit, Mawi Health, and Roche, says wearable consumer devices easily allowed for important biometric data to be tracked and synced to phones, tablets, and computers using Bluetooth.
With a paired app, devices are “always connected, always synched,” without users “fumbling with USB cables,” Vasylenko says. For healthcare practitioners, this continuous data tracking opened a path to an earlier and more accurate diagnosis. For patients, it promised to cut back on provider visits and hospital stays.
In 2018, the University of Pittsburgh Medical Center reported that it had reduced hospital readmission of Medicare members by 76% with a home-based monitoring program integrating tablets, patients’ mobile phones, and connected devices such as scales, blood pressure cuffs, and pulse oximeters. Participating providers were able to remotely adjust patient care plans using surveys, educational videos, and video calls or text messaging.
But connected medical devices can pose challenges, particularly for older, chronic care patients, those with low tech literacy, or people with accessibility limitations. What happens when the internet goes down? When the messaging on labels or buttons is unclear? Even minor errors can have disastrous consequences. (Imagine that extra zero in a botched Venmo transaction applied to an insulin injection.)
And patients aren’t clinicians. They aren’t trained on how to position their smart scale or attach a blood pressure cuff, leading to inaccurate readings. Sound alerts can panic users over clinically insignificant events.
So how can designers ensure that connected medical products offer safe, accurate, and comfortable experiences?
Design Principles for Connected Medical Devices
Every device will have its own challenges, but certain design guidelines will always apply.
Make controls easy. To minimize user errors, trade intricate controls and interfaces for a few large, clearly labeled buttons, and ensure that interacting with the device is simple for all users. That includes elderly people or those who lack digital fluency, people with physical or cognitive impairments, and people who may be under emotional duress in a medical emergency.
Consider how the device will be positioned when designing buttons and interactions. Is it wearable, or will it be attached to a wall or wheelchair? Will someone other than a patient—a caregiver, perhaps—need to access the controls?
Simplify instructions. According to Toptal designer Brian Pagán, medical terminology may unsettle or confuse users. (Even common words like “syringe” can be unfamiliar or disconcerting to some.) Pagán, who helped develop a suite of Philips connected health devices, says animated instructions on a screen work better than a brochure to teach users how to set up and use their device.
Choose icons to suit your target group. A Georgia Tech study found that older adults improved their compliance with care protocols when the icons on their mobile monitoring devices featured easy-to-read fonts and colors. However, exclamation points, the color red, and other alarming symbols can send misleading and even dangerous messages. Pagán cautions that these indicators also stress out users. In other words, look for a middle road between eye-catching and overwhelming.
Be proactive when necessary. Pagán cites the Philips Lifeline fall detection system as a model. The system includes a base station with a speaker and a large button that can be worn around the wrist or neck. Accelerometers, which measure a patient’s motion and position, function as a backup, automatically notifying responders of a fall. If responders can’t contact a patient through the speaker, emergency medical services will automatically dispatch to their home.
This proactive feature is crucial because “lie time,” or the length of time an individual remains on the ground after a fall, is critical to their recovery. In a San Francisco population-based study of 367 patients, researchers found that a lie time of 72 hours led to a mortality rate of 67 percent, compared to a 12 percent rate for patients who received care within an hour.
Treat users as equals. Copywriting for in-app messages and package designs should be warm and disarming, according to Pagán. When you treat people as equals, rather than approach them as patients, they tend to be more receptive to advice and more forgiving when things go wrong. Software updates, hardware glitches, and even misunderstandings of how to use the product will be easier for patients to handle if they’re starting from a place of trust.
Prioritize privacy and safety. To comply with the US Department of Health and Human Services HIPAA Privacy Rule, patient data stored on devices should be secured with an anonymized identifier. An app’s privacy settings should include a “delete all” button and a short-form privacy notice should summarize what data is being collected. Users should be able to opt out of sharing sensitive information on an itemized basis, which will provide an added sense of security.
Ensure digital equity. According to a 2020 report from Older Adults Technology Services (OATS) and the Humana Foundation, 42% of older American adults lack internet at home and those in poor health were up to twice as likely to be offline. Race, marital status, education, and income were also significant predictors of whether or not older adults had internet access.
To help address this, physicians and care teams are shipping remote patient monitoring devices to consumers as plug-and-play kits that include all needed components. They are easily synced by Bluetooth and are able to operate in an offline mode. Clinical information is saved to a physical data hub and, once connected to the cloud, data is transmitted to a cooperating care team’s electronic medical record system. While not synchronous without an internet connection, the system ensures information is preserved and accessible when needed.
Not Everything Needs to Be Connected
Because medical devices can affect a patient’s self-image, emotional state, and relationships, designers should evaluate whether connected features degrade quality of life. One 2013 study of older adults described participants who saw their at-home devices as upsetting reminders of their illnesses. In some instances, these devices were intrusive enough to cause embarrassment or social friction.
Mark Prommel, a partner and design director at the industrial design and invention consultancy Pensa, cites smart pill dispensers as an example of technology’s diminishing returns for some patients. Although they are intelligent in the sense that they dispense the right medications at the right times (and in the right doses), perform autonomous computing, and connect to a data hub, the dispensers are also low on emotional literacy, broadcasting unintentional yet constant reminders of aging and illness.
“This bulky device is sending me reminders and buzzing my phone,” Prommel says, imagining some older patients’ experience with the devices. “I used to have this nice, quiet little plastic pillbox that said ‘Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday,’ sitting on my windowsill. How much do I want to be reminded of this, all the time?”
Devices need to have a compelling reason to exist and demonstrate benefits for both healthcare teams and patients. For designers, that means having a clear idea of the target audience before beginning the design process. If a device design doesn’t serve users, no amount of UX finessing can salvage it.
“The first question that really needs to be answered is not ‘Can it be?’ but ‘Why?’” says Carrie McGrath, director of research at the Massachusetts-based design consultancy Loring Human Factors. “Why should this be moved to the home? Is it for the patient themselves? Is it for the caregiver? Is it to save costs for the overall healthcare system?”
Remote Patient Monitoring Comes With Privacy Risks
If instant access to patient data allows for early and better diagnosis, it also comes with risks to users’ privacy, says Greg Hamilton, Managing Director of Experience Research at Mad*Pow. Because data is transmitted between homes and medical facilities, it is more vulnerable to cyberattacks and hacking. In the US, data collected from wearables and smart home devices are not subject to HIPAA privacy protections unless it is used by healthcare providers, insurance companies, or clearinghouses for treatment, billing, payment, or operations. And some patients may be squeamish about trusting tech companies with their health records.
Yet Amazon’s foray into health services may signal that consumer attitudes about privacy are changing. Amazon’s Echo now lets users summon a physician from the telemedicine provider Teladoc Health using Alexa, and with an Alexa Together subscription, caregivers can remotely monitor family members at home. Falls are detected with wall-mounted sensors or wearable pendants, and an activity feed can be set to alert family members if an aging relative hasn’t talked to Alexa by a certain time.
For older adults who wish to age in place, and the caregivers and healthcare providers who assist them, ambient monitoring programs trade privacy for independence. Researchers in the CREATE Health Research Collaborative at the University of South Florida developed a pilot monitoring program, HomeSense, a network of 16 to 20 sensors that measure everything from sleep and bathing duration, to TV watching and time spent outside the home.
Information is sent to a web-enabled remote interface for long-term assessment of health and behavior, and alerts can be set up to notify healthcare providers and caregivers of urgent problems—for instance, if a person wanders off at night or fails to get up from a fall. The system has “collected more than 10 million hours of sensor data, with an average of 6500 sensor events per day per installation,” according to a study in the journal Health and Technology.
Sure, it’s intrusive. On the other hand, “there’s just so much human and financial value there,” Hamilton says. “It’s an easy answer because the health burden is so much higher in that population.”
Medical Device or Lifestyle Product?
Despite these technological leaps, Prommel, the Pensa design director, believes that the most successful connected devices will offer superior service design. Devices that feed into medical records and communication systems will help providers offer more targeted intervention, which will increase patient satisfaction with their care.
This need to integrate products into front-end (for the patient) and back-end (for providers and support staff) experiences will likely create more roles for designers. It may also mean that nimble startups with large user networks and aggressive growth ambitions still have a chance to beat out legacy companies.
Consider Sound Life Sciences, which obtained FDA 510(k) clearance for a prescription app that uses a smartphone or speaker to monitor breathing patterns. Or the remote diagnostic company Nanowear, which gained clearance for a wearable undergarment that monitors “patient vitals such as heart rate, blood pressure, respiration rate and physical activity,” and shares the data with SimpleSense, a remote diagnostic web platform.
Drawing data insights from devices that read the body in new ways, such companies may embody the way forward for at-home medical devices. Aesthetics could play a deciding role in which of these devices take off. Just as people flaunt their mobile phones, they may one day flaunt their medical devices, Prommel suggested. He points to One Drop, a sleek diabetes management platform with a starter package that includes a Bluetooth-enabled glucose meter, a chrome lancer, and a faux-leather carrying case with orange stitching.
Access to personal nutrition coaches via chat, social forums that connect users, and a rich data repository that can be mined to run predictive scenarios like “eight-hour glucose forecasts” are the sort of high-touch capabilities that could portend the future of at-home medical devices.
As medical monitoring technology becomes more sophisticated and widespread, designers may find that safe, secure, and easy-to-use devices need to be discreet and fashionable as well.