Designing Devices for the Body
“‘Sometimes, my heart feels funny,’” B laughs, “That isn’t really a helpful way to talk to your doctor about things.”
B is a 30-year-old woman who noticed a few years ago that her heart had irregular beats and that it’d happened before. It was previously so infrequent that she didn’t at first mention it to her doctor.
“The first time a murmur happened, I really didn’t think much of it. The second time, I recognised that it’d happened before. So I started paying more attention to my heart,” she recalls. “Once the murmurs got more frequent, I decided I ought to see someone!”
An electrocardiogram (EKG) turned up no discernible pattern, as the event only occurs for a few seconds a few times each month. Her doctors tried more EKGs but, because the test only measures a small point in time when she wasn’t having any issues, they gave her a wearable device to monitor her continuously for a month.
I chatted with B recently about what it’s like to live with a wearable medical device. As a designer, I want to know the limitations of her device and how improvements to it could improve her experience. This is especially important as the problem involves her health; she wants to be reassured that the device is actually helping her.
The device looks like something you might find on Darth Vader’s chest: A silver brick hangs from a lanyard around her neck. Four long wires spill from its base, stretching to leads stuck to her skin, the kind you see in medical dramas. The doctor’s office didn’t seem to have any other options for a wearable medical monitor. Her symptoms didn’t warrant full in-patient observation in a facility, but her doctors still wanted to monitor her condition.
Struggling with Devices
The device itself seems pretty high tech by all accounts. It monitors her heartbeat constantly and a phone with Bluetooth collects data, sending it in real-time to her doctors over cell networks via custom software. It’s not without user experience flaws, however.
“I have to replace the sticky pads on my skin every two or three days. They leave a sticky residue, which I have to scrub off with rubbing alcohol in the shower because soap and water doesn’t do much.”
She rubs a red spot next to a lead on her upper chest.
“Picking off the adhesive has left me with one or two abrasions. It really irritates my skin.”
The device certainly has a footprint, wires peek from under her shirt, and the phone in the faux-leather case worn on her hip isn’t small enough to fit in her pockets.
“I wish it were more like a Fitbit or something small. I don’t use any wearables, but I like that my phone can take my pulse through my camera or let me know how active I am on a given day. I just feel that maybe we could have something more elegant than this,” she tugs at her lanyard, “everything else just goes through my phone, why can’t this?”
Powering these devices is also a challenge for B.
“The charging is really annoying. I have to replace the unit batteries every four days, and this Blackberry-looking thing,” she rests her hand on the case, “needs to be charged every night and barely lasts a day on a charge. There’s a sticker on the back that boils down to ‘always be charging’.”
The phone is glossy and looks like a Blackberry with an integrated keyboard.
B remarks, “It’s actually an HTC Windows phone, believe it or not. As an iPhone user, the experience trying to do anything on this little phone is a bit infuriating.”
The phone tells her where the leads should be. She shows me the four leads, which must remain in the same spots.
“The red lead goes under my heart. The black one’s near my armpit. The green one’s five inches to the left of my belly button, and the white one is near my shoulder. I can’t be more than ten feet away from the phone while the leads are connected, otherwise it yells at me and I need to reconnect and re-calibrate,” she recounts.
Having to tote around an additional device to run a single piece of software is a challenge. She confesses that it feels like, “last decade’s technology,” running a Windows application on a phone that’s she’s not used to.
The interface of the software has a male torso that shows colored dots to indicate the lead positioning. B struggles to navigate the application, trying to find the home screen to show me more options. She says that if she removes a lead, the interface shows her which lead is loose with a red “x” over the corresponding lead and a vibration to alert her. As an example, she tugs out the lead attached to the white pad above her heart while she shows me the device. Nothing happens.
I remark on a blinking heart-monitor wave (called a ‘QRS wave’ when looking at an EKG, as it turns out) in the corner of the application.
“It’s not actually my pulse,” she tells me. “It’s just showing you that a pulse is being detected. I could run around the block and it’ll still pulse with the same frequency.”
I ask her about her trust in the device.
“The male torso, the vibrations not kicking in, the weird pulse thing? It’s impersonal, and I don’t trust this to be super accurate… But what can you do? I mean, what if I had an episode right now? This lead is still unplugged.”
The phone still hasn’t vibrated.
Having a Life
It’s not uncommon for people with devices like this to be pretty self conscious. They’re not something most people see very often, so many observers are curious and want to know more. B recalls being out on a date at a restaurant with her husband and getting looks from other diners, despite her attempts to hide the monitor under loose clothes.
“People see the lanyard around my neck, and they think I’m either in town for a conference or I have a camera or something. People ask me about it, but I’m really not excited to go into my medical history. I don’t exactly feel normal with this thing on. It’s pretty crappy, you know?”
B keeps the device on her at all times, except in the water. During showers, it comes off, but the pads attached to her stay on. B’s planning a trip to see family in California and is bummed that she won’t be able to really enjoy her in-law’s hot tub.
She’s also not looking forward to going through airport security.
“They always ask if you have any medical devices and select you for more screening. I’m really not looking forward to my time with the latex hands of the Department of Homeland Security.”
Everyday activities are a pain too.
“They say, except for taking it off when I get in the water, it shouldn’t interrupt my life at all. It’s one thing to say that; it’s another thing entirely when you’re using it,” B tells me.
The wires are constantly getting caught in her seatbelt, which is inconvenient for B because she drives for Uber and is constantly getting in and out of her car.
Dealing with Bureaucracy
Insurance for the device is also an issue. B is dealing with COBRA paperwork on top of trying to make sure she’s healthy.
“They’ve not processed the application,” B tells me, unamused. “So that means the company that’s doing the monitoring is being told by my insurance that we don’t have an active policy. I sure hope they’re actually sending this data over.”
Her healthcare providers didn’t help either. I ask her how much instruction she got and if they told her why the leads had to be in those spots.
“It made me feel like I was just being processed. I like knowing things, and it really felt like I was just a cog. The doc [cardiologist] was already out of the room seeing other patients by the time a tech brought in the device. It was really just ‘hook stuff up, and we’ll see you in a month.’”
It wouldn’t take much to make this product just a little bit better for users like B. For designers like us at Mighty, we’re used to making experiences work for users, regardless of technology.
We’ve seen time and time again that trust is an important factor when dealing with healthcare and medicine. Users want to have believe in the science helping them get better, and they want reassurance that treatments are in their best interests. Making sure software works for the user on any platform – especially ones they’re already familiar with – goes a long way towards improving interactions.
To that point, more personalization in the system could hugely improve user’s experience. Letting users create a profile would help them feel like the solution is unique for them, helping them personally get better, instead of getting the sense that they’re just a cog in the healthcare industry machine. Showing a personalized heartbeat, a photo of the user, or doctor contact info would help users feel more invested in their healthcare. We know that these personalized touches are key for gaining user buy-in with solutions.
Letting users use their own phones would also improve the user experience. Thoughout much of the user testing we’ve done at Mighty, we know users are much more comfortable with devices and design paradigms that they use on a regular basis and are more adept at using software made with those platform experiences in mind. Many cross-platform tools are available to keep underlying software logic in a central language, while focusing on the user experience of the software or hardware for individual platforms.
Having experience in hardware and physical product design, the device itself might be harder to change in as many drastic ways. Some small changes, like personalized fitting of leads, would be a big improvement and might not require much time in technicians’ busy schedules. Keeping the leads custom fit and measured to an individual user, with the unit out of the way–rather than hanging around a user’s neck on a lanyard with wires spilling out–would help the user feel less self-conscious while, at the same time, preventing snags and the interruption of service associated with a lead coming loose. These sorts of balancing acts between different users and different times are key to success in the wearable space.
Responsiveness from the device is key. Users have grown accustomed to speed in device response to input. When information is critical, as medical monitoring data often is, systems should respond quickly and give feedback to users. The fact that when a lead was removed, the system didn’t have an immediate response was troubling to B. Had the system responded right away, it would reinforce user confidence that the data was actually being gathered for her doctor.
When we design any product, empathy for the user is first and foremost. As designers, we strive to know as much as we can about the bigger environment the problem takes place within – to see how to keep little problems, or in B’s case, numerous problems, from becoming big ones. Researching the users limitations with products, their everyday hassles, and their need to trust their tools gives designers the insight we need to make products that help and delight. It is vitally important in so many circumstances that the user is be adept and comfortable with their device – fool proofing saves lives. Going beyond beautiful when designing is not just a straightforward tagline, its a vital, necessary service.