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issue: August 2004 APPLIANCE Magazine

Medical Appliances
New Considerations for Medical Appliance Designers

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by Aaron Oppenheimer, principal product behaviorist, Design Continuum (West Newton, MA, U.S.)

Medical devices are no longer just medical devices—they are consumer products. In the past, medical product manufacturers stressed the medical efficacy of their devices over all other considerations. However, today they are borrowing a page from the consumer product designers’ playbook.

Manufacturers are realizing a key insight; one that is changing the entire medical appliance field: users of medical products are consumers, who bring the same interests and biases when shopping for medical devices as they do when shopping for housewares and other goods.

This is quite a revelation for an industry that hasn’t put much emphasis on the emotional needs and aspirations of its consumers. Everyone knows what a home medical appliance looks like—it’s beige, it’s squared-off, maybe it beeps unpleasantly. The aesthetic philosophy seems to have been, “don’t bother—people need the products, regardless of how they look.” And while it may be true that people need the devices, it doesn’t mean they don’t care about aesthetic friendliness.

It’s not only user preference for nicer looking products driving the change. Research is pointing to new thinking about the design of product behavior. In their 1996 book, The Media Equation, Clifford Nass and Byron Reeves describe research in which they found that people relate to computers and technology in the same ways they relate to other people. The implication is that designers need to design devices that behave like people, emoting the same respect and honesty expected from human beings. No longer is it appropriate to flummox consumers with cryptic error messages, rude prompts, or extra hoops to jump through in order to get a task done.

Consider the humble glucose meter—a hand-held device used by diabetes patients to measure the amount of sugar in their blood. Several times a day, the patient pierces a finger and deposits a drop of blood onto a small plastic test strip that he or she has previously inserted into the meter. Meters have been available for decades, and for most of that time they had the standard, home medical appliance look about them. Flat, beige, and sterile with puzzling icons on a tiny screen, these products screamed, “I am a medical device.” That was fine back then—diabetes patients really did need the products and were grateful for them.

Fast-forward to today. At least 10 manufacturers have meters on the market, all available at a very affordable cost (although a meter may carry a sticker-price of U.S. $90, most have hefty rebates when a patient trades in an older model. Newly diagnosed patients often receive obsolete models from their healthcare providers for trade-in).

Now picture yourself buying a meter at the drugstore. The products on the shelf are all roughly equivalent in performance, so what distinguishes them from each other? What you find today is much different from the selection of the past: meters in colors; meters with large, clear screens; meters with features to not only measure blood glucose but to manage diabetes as a condition. Ads for these products include endorsements by the likes of B. B. King. With the American Diabetes Association reporting 1.3 million new cases of diabetes diagnosed every year, the glucose meter has truly become a consumer product, much like a CD player or spatula.


Figure 1. Frequency/Intensity Charts for a Glucose Meter and a Hypothetical User Over Time

Above is a chart for a new user, showing that testing blood is frequent and requires concentration, and that tracking trends is less frequent. Below, a chart for the experienced user shows that testing blood is less intense, and that trend tracking is done more frequently and with increased concentration.

For both users, warning of high glucose is infrequent but very urgent. Designers must consider that the relationship between user and product will change over time and can gain design insights by plotting the changes on Frequency/Intensity Charts.


Products for People

Once medical products are viewed as consumer products, many opportunities present themselves. A medical device can do more than support the physical need for medication or monitoring. It can assist, advise, and support the patient, providing for emotional needs as well as medical ones. Through form (shape, color, texture) and behavior (conversational interfaces, friendly messages), designers are creating devices that deliver medical intelligence.

In his 1997 book, The Innovator’s Dilemma, Clayton Christensen likens the purchase of a product to hiring an employee. This metaphor works particularly well with medical appliances. When a company hires an assistant, it screens for personality, occupation, and aptitude. Is this person easy to get along with? Does he understand the job? Can he perform the tasks? This can be applied to designing products. For example, organizing the features of a modern glucose meter requires considering the “occupation” of the device. The challenge for the design team is to structure the features to provide the highest value to the user.

One mechanism that places specific functionality into the overall context of a device is the Frequency/Intensity map, a simple chart that plots a function’s frequency (how often the user performs the function) against its intensity (the level of importance, concentration, or stress associated with the function). For example, testing blood is a frequent and important activity (see Figure 1). Tracking trends in daily glucose readings is less frequent and less important—some patients may not use this feature at all. Alerting the patient to a dangerously high glucose level is a rare occurrence but is also very important. This simple technique for mapping the functions of a device helps organize physical and on-screen interfaces.

In addition, considering how the Frequency/Intensity map changes throughout time is instructive: certain features may be used more often when the device is new, but less frequently after a few months. Other features may become more important as the user acclimates to the device. By understanding the points where features change positions on the map, designers can provide patients with the kind of support they need most.

Know Me, Know My Condition

The most important implication of this new attitude toward medical products is that “efficacy” must be redefined. Designers and companies can no longer measure only the medical effectiveness of a product, but must also measure acceptance. If device A treats a condition better than device B, it is less effective if device B is more highly accepted (purchased, recommended, and used). This disrupts manufacturers’ traditional route to the drugstore shelf—develop technology in the lab, hold clinical trials, gain regulatory approval, distribute—because it requires deeply understanding who the patient is, what he or she likes, wants, and buys.

When medical devices are viewed as consumer products, manufacturers must consider trends in product design and even fashion. On the shelf, products are competing against each other for consumers’ attention, so it becomes vitally important to understand the attributes that attract consumers. Everything from medical efficacy to readability, learnability, shape, and color is important to consider when creating products that truly connect with consumers.

This is not a tradeoff between effectiveness and aesthetics, but a broadening of the definition of creating medical products. Understanding how consumers perceive a device and the benefit it delivers is as important as what the device actually delivers.

Redefining Quality

Medical appliances are designed to improve consumers’ quality of life. As devices flood the market, consumers get accustomed to a certain level of quality. At that point, other aspects come to the fore, including physical and behavioral compatibility with patients’ lifestyles.

In competitive markets, product value is created when medical device designers and manufacturers give the same attention to the life and lifestyle of the patient as they give to the science behind the medicine.


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