If You Give a Mouse a Cookie

The challenge of designed user-oriented medical devices

Melissa Parish

Everyone knows someone
      

Me You Your kid Friends Athletes Musicians CEOs

24x7

We live in the future

Easy fix
No site reminders  Not fine enough granularity  Battery change resets IOB

It takes time
iPhone app up to 20 days Speed Medical devices 1-3 years Safety

Middle men
Doctors  Salespeople  Insurance companies

EpiPen vs. Glugacon

Dear Steve Jobs,

Amy Tenderich’s Open Letter

“…We are, of course, deeply grateful to the medical device industry for keeping us alive. Where would we be without them? But while they’re still struggling with shrinking complex technologies down to a scale where we can attach them, hard-wired, to our bodies, design kinda becomes an afterthought. …”

Diabetes Mine Design Challenge

  

Finn the Glucose Fish - Play-Skool like glucose monitor Test Drive - driving safety system Zero - micro-sized combo insulin pump/glucose monitor

Something to drink

Jetpacks and flying cars

Reference
       

Schuyler’s Monster Amy Tenderich’s Open Letter to Steve Jobs Diabetes Mine Design Contest Charmr Bayer Contour USB glucometer Medgadget Proloquo2Go xkcd

If You Give a Mouse a Cookie
The challenge of designed user-oriented medical devices

Melissa Parish

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Good morning. My name is Melissa Parish and I am a cyborg. I use various medical devices to manage my Type 1 diabetes. In this age of technology that has phenomenal cosmic power, we have gotten a little spoiled. It is no longer enough to simply make devices that –work-. They need to work –beautifully-.

Everyone knows someone
      
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Me You Your kid Friends Athletes Musicians CEOs

Everyone knows someone who uses a medical device. I have an insulin pump. So does Nick Jonas. Stephen Hawking uses a voice synthesizer, as does Roger Ebert. A friend of mine uses a video magnifier to play board games. We are everywhere and we are just regular people, with regular lives, who just happen to need some sort of medical technology.

24x7

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Living with a medical device is not like using a cell phone or an appliance or traffic lights, which can be typical subjects of usability studies. These devices are used every single day, close to 24 hours a day. The top left device is a video magnifier like I mentioned before, although I would like to point out that they didn’t always used to look that slick. In the past, my friend had a whole projector setup with a relatively large monitor. Now he’s got a smaller projector and screen, and will soon move to using a device like this one. The top right is my insulin pump. =) The bottom left device is a CPAP machine which, while not worn 24/7, is definitely subject to the rigors of usability. The bottom right is an Augmented and Alternative Communication device (or AAC), which helps people with various forms of communication issues. Medical devices need to not only stand up to the mechanical rigors of constant use, but also the more emotional aspects of being (quite literally) tied to a machine.

We live in the future

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We live in the future, and the future is awesome. We’ve sent rovers to Mars, we upgraded a telescope in deep space, we can view nearly any street in the entire world, right from our own bedrooms. The iPhone can take pictures, send an email, locate itself via GPS, record music, play games, translate languages, scan barcodes, check the weather, and oh yeah: make phone calls. Engineers and designers are doing amazing things for consumers and industry. But why hasn’t the medical device industry kept up?

Easy fix
No site reminders  Not fine enough granularity  Battery change resets IOB

5

My insulin pump is an amazing thing for sure. It keeps me alive and lets me do anything a “normal” person can do. However, it seems like there are a ton of tiny issues that, if this was a regular consumer device, could be fix within a matter of weeks In order to keep the area where the insulin is being infused healthy, I move the infusion site around every 2-3 days. Wouldn’t it be great if my pump reminded me to do it? Not so! I have to rely on my own 3 rd party methods. There is a lot of customization in the pump, but there are some things that just aren’t customizable enough. When I tell my pump I’m having lunch or something, it uses an insulin-carb ratio to calculate the amount of insulin I need. 1 unit per 7 carbs isn’t really enough insulin, but 1 unit per 6 carbs is too much. Why isn’t there a 1:6.5? I had to change the battery on my pump yesterday. What’s really weird is that doing so erases a lot of things that I think should be stored in memory: how much insulin is in the cartridge, how much insulin I have “on board”, what temporary basal rates I was using. These are software issues! Even I probably know enough computer programming to fix these issues. Why, after a device has been on the market for years, do these problems still exist?

It takes time
iPhone app up to 20 days Speed
6

Medical devices 1-3 years Safety

It’s all about a balance of speed and safety. As I’ve mentioned before, my insulin pump quite literally keeps me alive. The designers can’t take any chances that a small bug in their software could create a glitch that could kill people. Rigorous testing needs to be done to ensure that it can handle every possible combination of things and still deliver insulin the way it’s supposed to. From a PR perspective, no one wants to hear that something is being recalled because of a software problem. Currently, there are plans for a new 501(k) approval process for medical devices that are similar enough to pre-existing devices. Most of the time, we are not reinventing the insulin pump, just making incremental improvements. In the software world, you can just deliver a patch that users are forced to download. In the medical world, getting that update to all users is a little more difficult.

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Middle men
Doctors  Salespeople  Insurance companies

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These are not actually consumer devices. I cannot simply go to the store, pick out an insulin pump I like, and go home. I have to meet with my endocrinologist, who gets their information from a salesperson, and then the whole thing has to get sorted out through the insurance company. Because of all these hurdles, I believe that the medical device manufacturers sometimes forget about the fact that these things will be in the hands of the users more of the time. When I got my insulin pumps (both my old one and the one I’m using now), I set everything up myself and figured it out without the help of a “professional.” This apparently is mostly unheard of. People will just sit there with their unopened box of magic and wait for the trainer to show them what to do. In my opinion, if the product is designed well, a user should be able to just pick it up and go.

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EpiPen vs. Glugacon

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There are some things that the medical industry has gotten right. The EpiPen is supremely easy to use. 2 steps and that’s really it. You never see the needle, so everyone can use it. Glucagon (which is used to treat severe hypoglycemia), on the other hand, is a small nightmare. The instructions list 4 steps, all of which have to take place exactly as shown. There are a number of possible failure points, which could result in delayed treatment. Not to mention that some people are squeamish about needles and may not be able to help someone who needs Glucagon.

Dear Steve Jobs,

Amy Tenderich’s Open Letter

“…We are, of course, deeply grateful to the medical device industry for keeping us alive. Where would we be without them? But while they’re still struggling with shrinking complex technologies down to a scale where we can attach them, hard-wired, to our bodies, design kinda becomes an afterthought. …”

9

Amy Tenderich is a prominent diabetes blogger with her hands on the pulse of the diabetes world, both from a user perspective (she has Type 1), but also from an industry perspective. In 2007, she wrote an open letter to Steve Jobs about the state of medical design. I have the link for the full article at the end of this PowerPoint, but what’s more important is what came about as a result of that letter.

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Diabetes Mine Design Challenge

  

Finn the Glucose Fish - Play-Skool like glucose monitor Test Drive - driving safety system Zero - micro-sized combo insulin pump/glucose monitor

10

The Diabetes Mine Design Challenge. Once a year, she puts out the call to everyone! to design something to improve life with diabetes. Here are the top 3 designs from 2010. Finn the Glucose Fish is a Play-Skill like glucose monitor to help children test their blood sugar more often. It’s cute, fun, and super easy to use. It looks more like a toy, which helps makes kids feel more at ease with their diabetes. Test Drive is a system that would ensure that people with diabetes are driving while at a safe level. It would detect if you are having a low blood sugar and would alert the driver. Zero is a micro-sized insulin pump combo along with a continuous glucose monitor. Right now, these 2 devices are HUGE. Wouldn’t it be great if you only had to carry around something tiny. This challenge has been great in getting people to think more about design and medical technology.

Something to drink

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I have confidence that medical device design is moving in the right direction. All the products here are fantastic iterations of once-clunky designs. The top left is the Charmr insulin pump. The insulin is stored in a “pod” which is attached to your body, then you use this super sleek touch screen remote to control it. You can wear it as jewelry or easily stash it your pocket. This concept was a direct result of the Design Challenge. Adaptive Path took it upon themselves to design something gorgeous for people with diabetes. The top right is a surprising first: a glucose meter built in to a USB drive! Most devices have their own proprietary cables and proprietary software. This meter allows the user to really get into the data to help increase control. The bottom left is a wearable CPAP machine. We all know those bulky masks and tubes and hoses. This plush CPAP snuggles around the persons neck and is much more appealing. The bottom right is an app called Proloquo2Go. It’s essentially the same technology as the AAC device, but as an iPhone app.

Jetpacks and flying cars

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Even though consumer and medical device technology is growing amazingly, we will always want something better. And it is up to us to create it. Any questions?

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Reference
        13

Schuyler’s Monster Amy Tenderich’s Open Letter to Steve Jobs Diabetes Mine Design Contest Charmr Bayer Contour USB glucometer Medgadget Proloquo2Go xkcd

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