Futuristic visions of ubiquitous telemedicine are suddenly knocking at the door. With the events of 2020 accelerating the transformation, it’s vital that we grasp the opportunity to take stock of telehealth device design. The implications of innovation are significant. Patients will be their own technicians; clinicians will be expected to roll technical support and data science into their skillset. The time to confront the challenges for user interface design is now.
Before I dissect the hurdles and opportunities in more detail, let me nail my colours to the mast. Future success in device design for telemedicine depends on cultivating a patient centric philosophy. It must inform a holistic approach that embraces everything from form factor, aesthetics and the attitudes of patients as consumers to vital considerations such as trust and confidence.
Read Gavin Troughton's blog on telemedicine
I’ll begin with ease of use. Introducing telemedicine devices into our homes invites comparison with the consumer devices already resident. Slick devices from Samsung, Apple, Sony, Philips and the rest have conditioned us to expect design perfection. We love the acute attention to detail and the way they are so simple to use. But these emotional responses contrast starkly with the cold technical complexity of conventional medical diagnostic devices operated by highly skilled clinicians.
Eliminating barriers to use
Telemedicine turns tradition on its head, putting the tech in the hands of patients and expecting them to operate it correctly. This means great care must be taken to eliminate barriers to use. Connectivity issues, security and login problems – and anything else that could prevent safe and effective use – must all be taken into consideration.
Crucially, a new perspective on the aesthetics of a design is needed. It’s imperative that the right balance of technical capability, clinical efficacy, ease of use and consumer appeal is conveyed. Maybe we need to seek inspiration from sci-fi movies to anticipate the design properties that will prevail in this clash of the medical and consumer worlds. Or perhaps we reflect on the instincts of the tech giants that are already blurring the boundaries of the two spheres. Even a couple of years ago, my colleague Matt DeNardo was exploring how Apple was leading the desirability charge with its incredible consumer health Apple Watch Series 4.
Whichever way it lands, we must remember that patients are consumers in this space. They’ll no doubt exhibit consumer-like behaviours and levels of (in)tolerance to inferior design that hasn’t carefully considered their user experience.
A major concern of relocating medical devices to the home is that it invites misuse, both deliberate and accidental. Sensors can be attached incorrectly; usage patterns can be erratic… there is a host of unforeseen, and predictable, possibilities. So, it is vital for detection of incorrect use to be prioritised and corrective user guidance given, especially for older patients. The myriad changes of age-related degeneration make it vital that we understand the capabilities and needs of our target populations. We must keep these factors in mind as we design for usability – as in our Aalto example.
Technical support in the home
Here’s another key question we must address: who provides the technical support for in-home medical devices? As I’ve already made plain, ‘patient consumers’ naturally expect seamless and intuitive experiences. Significant investment is required to provide the backend systems to run fast and efficient digital services. This is essential to ensure patient data can be captured, communicated and stored.
Adding layers of automated setup and technical support can be complicated to design for, so it seems likely that many will opt for human-based support lines. But will the patient expect a qualified healthcare professional to be at the other end of the line, particularly if their health or health data is at stake?
A further complication comes with the logistics around durable equipment that may be loaned to a patient for a short time. Maintaining and cleaning of devices between users becomes critical to a reliable service and patient confidence. Designing hardware for minimal physical calibration is one way to tackle this. But that’s not always possible for systems providing sensitive measurements, so a physical maintenance facility becomes essential. And designing robust devices from durable materials and simple forms supports easy cleaning. Successful multi-patient hygiene demands careful design for an appropriate level of reuse versus disposability, though this may be difficult if sensors themselves are expensive.
Another aspect to consider is how clinicians themselves will adapt to working with telemedicine data. The approach potentially offers significantly greater volumes of data over a much longer duration. It’s vital to provide options for how this data can be digested without overwhelming already hard-pressed caregivers. The benefits to patients and HCPs are huge, but only if clinicians can augment their existing methods with sensible added insights rather than drowning everyone in oceans of data.
Trust and confidence is paramount
Medical devices often suffer from low levels of social acceptability. They remind patients of their illness and can be regarded as an outward indicator that creates social embarrassment. Overtly medical devices can feel intrusive in the home, and body-worn devices can create awkwardness for patients in public. So serious consideration should be given to how telemedicine devices will be perceived in a variety of use environments. It’s especially important to contemplate the overall experience of living with a device, rather than just during active use, as my colleague Katie Cornish explains.
Telemedicine adoption will also require a shift in attitude to greater trust in consumer-grade medical devices. The traditional approach of highly trained operators using sensitive and complicated clinical-grade devices is reassuring for both patient and caregiver. But we are reaching a pivotal watershed, when the application and control duties will be put into the hands of the patients themselves.
To be usable by a wide range of people, devices will need to be simplified in their complexity and robust in their measurement. A loss in sensitivity could be counteracted by an increase in measurement duration or frequency, which may also overcome the ‘white coat hypertension’ effect of traditional approaches.
Supplementary diagnostics could be included to automatically crosscheck readings and detect false positives/negatives. Whether this additional data is processed at the edge, or transmitted along with the primary signal data, will be a factor of local processing power and the data security requirements. We’ll explore that later in this series of telemedicine articles.
Maintaining user confidence
As more sensitive patient data is transmitted between the devices and the service providers, the latter will have to lead the way in security. They’ll have to not just protect the data but demonstrate to patients that it is in safe hands. Every breach will cut deep and wide. Service providers risk jeopardising their business if user confidence in their product is lost.
Another angle on trust is patients accepting the technology and the advice it provides. Effective communication of readings, diagnoses and guidance are paramount. It’s likely to be the greatest differentiator between different product manufacturers that users will experience. This is why the use of behavioural modelling techniques and extensive user testing to understand all needs throughout the usage cycle is so essential.
Without face-to face interaction, many patients may struggle to understand the results or advice they are given. Effecting the changes in behaviour that come as part of an AI-derived diagnosis will be unlikely if the message can’t be tailored to that individual’s level of understanding. It must match the ability of human interaction to do that.
Taking on responsibilities
As a final thought, everything mentioned so far will only be possible if patients are willing to take on these responsibilities for themselves and can remain actively engaged throughout testing or treatment. Our lives are already filled with gadgets that demand our attention and suck at our free time. For some, a visit to the doctors for a diagnostic test is a comfortable compartmentalisation of their time. Relocating this duty to their homes will feel uncomfortable.
That said, I firmly believe that benefits to patients and clinicians outweigh the potential negatives. The opportunity to radically improve public health through telemedicine – especially as so much of regular healthcare service is constrained as we emerge from the pandemic – is profound. Some of our clients have already taken the first tentative steps towards telemedicine and remote diagnostics. Now legislation is following suit, opening the door for smoother development.
The market will soon be awash with telemedicine solutions. But only the most successful will have anticipated, considered and acted upon the many issues at play. Watch out for the next in our series of articles, which will examine architectural approaches to telemedicine systems. Meanwhile, drop me an email if you’d like to continue the conversation.
