Feature Article

By: Alun Wilcox

The first five years of my professional design career were spent working in the prosthetic limb industry and in that time I became knowledgeable about this specialist area. For the past 20 years I have been working in consultancy and I am now out of touch with the prosthetic industry, but have scratched the surface of numerous other areas of the vast medical and pharmaceutical markets. My experience ranges from low-cost and high-volume disposable continence control devices to high-cost and low-volume drug delivery equipment. A walk around the 17 halls at the Medica show in Düsseldorf, Germany, each November clearly demonstrates the immense diversity of design challenges that exist in this market (and this exhibition does not really cover the pharmaceutical industry). No one can be an expert in all aspects of this industry, but what I can offer is an opinion of how the design challenges have changed over the last 20 years and hint at how these may be changing in the future.

 

One thing is certain: technology has raced forward at an amazing pace. In 1966, in the film Fantastic Voyage, Raquel Welch was miniaturised and sent around the body in a tiny submarine, as was Dennis Quaid in Innerspace in 1987. Thankfully, we still cannot miniaturise humans, but there are now pills with miniature cameras that can be swallowed and transmit images of the journey through the digestive system for up to eight hours. It is possible to have a microchip in every pill. Ingestible event markers developed by Proteus (www.proteusbiomed.com) are tiny, digestible sensors made from food ingredients, which are activated by stomach fluids after they have been swallowed. They can transmit compliance data to an externally worn device and even conduct diagnostic readings along the way.

 

Where once orthopaedic surgery used to be solely reliant on a surgeon’s experience and skill, technology has enabled the development of robotic navigation systems and embedded sensors to help align and monitor implant positioning and wear over time. In a recent conversation with a manufacturer who has a navigation technology system to support the company’s implant range, I was interested to hear that his company has not sold a navigation system for three years because surgeons do not want them—they prefer to rely on their skill and experience. The implant company must have one, however, to be in the tender system to sell its implants.

 

This may be a reflection of this particular company’s system and is not meant as a condemnation of all systems of this type, but it does raise an interesting point: was this technology push or needs pull? We know technology can eventually enable us to do anything we want. The question we (at PDD) are always trying to answer is: What is the need, and what will add maximum value for the end user? It is in this area that the design industry has developed significantly over the past 20 years.

 

In the past, companies would come to design consultancies with a brief to design a product. Now they come to us with much more open challenges: How do we create brand loyalty for a drug that is about to come off patent, or how can we add value in a price-sensitive commodity market?

 

Twenty years ago, designers and engineers would enthusiastically visit a few end users to try and understand the context of use—the process—and to empathise with users. I remember wearing a water-filled colostomy bag for a week to try and understand the challenges patients faced, and this was greatly appreciated by the user focus group when I presented concepts in response to the experience. Now, understanding the challenge is considerably more scientific. PDD’s human sciences team made up of anthropologists, behavioural researchers and human factors engineers work closely with designers and engineers to understand living with a medical condition. We use mapping techniques to understand the complexity of therapies in terms of physical requirements, the process journey and the emotional aspects of how the condition and therapy impact patients’ lives. We now talk to all the stakeholders along the journey to understand their touch points and needs at each interaction. We are looking for opportunities to improve the experience of the whole journey from dispatch to disposal to deliver solutions that go well beyond the product. Our trends analysts compare research insights against macro trends to understand what could drive change in the needs identified in the research by the intended launch date. The aim of all of this is to identify real needs and find innovative technically and commercially feasible holistic solutions.

 

The Merck Serono easypod (www.merckserono.net) employed this process (Figure 1). It is a sophisticated electromedical device used for self injection of growth hormone therapy. The identification of real needs came from research with families living with the condition and with clinician stakeholders involved in the prescription, training and monitoring. The approach has been highly successful.

 

As in medical science, technology has transformed the design and development process in recent years. Advances in computer aided design (CAD) and simulation tools have greatly contributed to designers’ and engineers’ ability to resolve problems and develop robust designs. Rapid prototyping materials and technologies have also helped us realise solutions in even shorter timeframes.

 

From a design perspective there has been a gradual consumerisation of most medical products. Patients and clinicians are consumers, and there is a growing awareness and demand for good design in all aspects of life. Since the explosion of mass consumption and the globalisation of brands in the “designer 1980s,” consumers expect the phones we use, the products we buy for our homes and the tools we use for work to be well designed and, therefore, they do not want to be stigmatised as sick or different by products we use to maintain our health.

 

Hearing aids have gone through an interesting evolution. In the past, hearing aid wearers were instantly recognised as the people with the beige ear plug and cable leading to the small beige box in their pocket. Now it is almost a social uniform to have white earplugs and cable leading to a white (or brightly coloured device) in your pocket. It is estimated that approximately 70% of people who should be using a hearing aid still do not and the majority of these do not because of the associated stigma. Even though advances in battery and digital technology have now enabled miniaturised devices to be produced that are almost invisible in the ear, there is still an adoption issue that needs to be overcome. The solution obviously goes beyond the product. To address these kinds of issues, companies have to understand the relationship between people and products from a cultural perspective. The science of semiotics can be employed to understand the subconscious codes to ensure that target users react to products in the desired way across different markets.

 

The consumerisation of medical products has also come about because technology advances have now enabled the move towards more diagnosis and treatment in the community and in the home. Products such as the first insulin injection pen, the NovoPen (www.novonordisk.com) in 1985 paved the way. Now, many blood glucose monitors are difficult to distinguish from MP3 players.

 

Designers have made it easier for people to administer their therapy. The big challenge now is how to inform and encourage people to maintain adherence to their therapy and manage their condition. There is a lot of interest in the area of telehealth, e-medicine and connectivity in relation to well-being and compliance monitoring. The telecoms infrastructure exists to allow it all to happen, and systems such as the Vitality GlowCap (www.vitality.net) claim 85% adherence rates. GlowCap is an Internet-connected pill bottle cap. It illuminates, plays a melody, and even rings a home phone so patients don’t forget to take their medication. It can send weekly emails to remote caregivers, create accountability with doctors through an adherence report, and automatically refill prescriptions.

 

Bayer has introduced DIDGET (www.bayer.com) to encourage diabetic children to be compliant with their blood glucose monitoring. The device interfaces with a Nintendo games console and children can earn reward points for blood glucose test results within their personalised target range, the number of tests per day and the minimum time between tests. They can also earn bonus points for consistently testing at least three times per day every day for at least one week, and up to 90 days. Children can use these points to purchase items in the games, unlock mini-games and customise their experience on Bayer’s DIDGET World.

 

The company has realised that it must consider the needs of children and adults in different ways. The technology is the enabler, but it must be pitched at the level that is appropriate for the target end user groups. To meet the needs of the diabetics who want to really manage their condition, they have developed Contour USB. This is a blood glucose monitor that enables the patient to plug the device directly into a computer and download test results and monitor compliance.

 

The technology convergence seen in the consumer sector—the video, camera, music player, phone and satellite navigation system all in one device—is also happening in the home diagnostic market. Devices enabling self monitoring of vital signs such as blood pressure, blood glucose, oxygen saturation, pulse, body temperature and body weight as part of telehealth systems are now available. Patient data/vital signs can be transmitted daily, but this raises the question: where is all this data going and who is going to do anything with it?

 

Currently, our healthcare systems are not set up to cope with this growing flow of data, even though a policy of prevention would save the systems a fortune. I have never understood why we don’t have annual healthcare Ministry of Transport tests as we do for our cars? Why do we need to be better informed about the health of our cars than our own bodies?

 

Even though healthcare systems do not know how to handle—or perhaps do not want to handle—this growing mass of data, increasing numbers of individuals do. The view of the doctor as the revered font of all medical knowledge has changed. Of course, no one can be expected to understand the mass of medical knowledge anyway. Internet access to this knowledge now enables individuals to better understand and even challenge diagnoses. Patient power has been enabled by the information revolution and social networking sites such as www.patientslikeme.com, but these have not merely benefited knowledge-thirsty individuals. It has been suggested that data collected on these kinds of sites contributes more to medical knowledge than all academic research activities. Scientists and clinicians, as well as the general public now refer to these sites for data. More people in the world have mobile phones than have access to healthcare, so this is an inevitable vehicle for people to use to become better informed about and to manage their own healthcare issues.

 

Pressure to manage and reduce healthcare expenditure in many of the major markets is also driving change. The big pharmaceutical companies are going through a transition and they will no longer be paid for the supply of drugs, but on measurable outcomes. Holistic solutions to healthcare will need to be considered with a clear focus on the patient journey, not merely concentrating on regulators, payers and clinicians.

 

It has been predicted that the information revolution will be transcended by the knowledge revolution over the next 20 years. The rapid spread of knowledge combined with advances in technologies such as genomics, artificial intelligence, virtual reality, nanotechnology and supercomputers will make the concept of personalised medicine a reality. Entelos (www.entelos.com) has developed Physio-lab, virtual models of human disease. This kind of model is being used to simulate risk and predict drug effect to improve the drug development process. The vision now is to one day be able to create an avatar of each of us, based on genome screening, which will enable doctors to simulate and review potential health risks over time and decide with patients how they could mitigate the risks through medication or changes in lifestyle. Giving people choices about the management of their health with more accurate and early diagnosis of potential risks will change the emphasis of healthcare to prevention, which can only be a good thing.

 

As always, the role of the designer will be to humanise the interaction with the technology, to engender trust, offer control and minimise risk from a clinician and patient perspective. If healthcare technology can keep me alive for another 20 years, I look forward to reading about the predictions in your 40th anniversary edition! 

 

is Director of Medical at PDD Group Ltd,
87 Richford Street, London W6 7HJ, UK
tel. +44 20 8735 1111
e-mail: alunwilcox@pdd.co.uk