At PDD we like to keep one eye on the horizon, scanning themes and emerging trends across the healthcare sector to understand what’s next. As the rise of digital health and therapeutics continues, we take a look at what this means for the patient experience and what opportunities lie in the area of self-care and self-management.
In recent years, there has been a significant growth in investment in healthcare-driven AI, in response to the accelerated demands for remote healthcare systems. We are seeing an increase in development of monitoring apps, digital triage systems and home-care devices aimed at providing healthcare support to patients and shifting some aspects of monitoring and treatment away from clinical settings.
Software, in the form of mobile health (mHealth) apps, is more and more often being prescribed by clinicians as a supportive counterpart, and in a few cases, as an alternative to drugs. Yet, while these apps pose many opportunities to enhance the patient experience with real-time feedback and increased healthcare touchpoints from the comfort and convenience of their homes; significant challenges around high patient dropout rates still remain.
Addressing this challenge of retention, mHealth apps have gone some way to increase patient engagement with push notifications, elements of gamification and connection to support groups or healthcare professionals. However, with even more emphasis now on digital healthcare systems to aid self-care and self-management, we ask: How might we facilitate a deeper level of connection for patients with digital healthcare systems to encourage better adherence and lasting, positive behavioural change?
Emotion and Function
A starting point perhaps would be to consider the patient in a holistic manner, placing their needs at the centre of solutions to create adapting approaches to healthcare that take into account not just the physiological aspects of a condition, but also the psychological effects that a condition can bring… fear, uncertainty, doubt, anxiety, apprehension, desperation, relief, hope.
While undoubtedly digital health solutions need to focus on functionality, be straightforward to use, and instil confidence in the patient; they can often lack a ‘human’ quality, which is where real connections happen. The emotional burden of health conditions heightens the need for empathy, understanding, patience, pace, contextual awareness, and demands a responsiveness that is personal to an individual’s situation.
Driving more natural and authentic Human-Machine Interactions (HMI), Emotional AI is a branch of Artificial Intelligence (AI) that can recognise, interpret, and respond to more emotive channels of human communication. It uses AI to detect both verbal and non-verbal signals, picking up on anything from voice inflections to facial expressions, essentially creating a series of behavioural biomarkers.
The use of Emotional AI is starting to emerge across a wide range of industry sectors, from smart home systems to automotive, digital marketing to retail, and even in the financial sector. The aim of all these applications is to create a deeper connection with users through systems that can anticipate needs, and automatically adapt their outputs based on even the most subtle of human behavioural cues, without the need for excessive data input by the user.
Here we look at the most relevant examples to explore the opportunities they might bring for future healthcare applications.
The evolving personality of AI
AI with a personality that evolves over time is an intriguing concept, perhaps. But that’s exactly what London-based robotics startup Emotech explored through their voice-controlled home assistant concept, Olly. To differentiate it from other similar systems such as Alexa, Siri and Google Home; Emotech proposed using machine learning algorithms that would ‘teach the system to gradually be more like its owner’, allowing the user to train Olly.
The concept could detect and interpret facial expressions, voice inflections and verbal patterns, enabling it to start conversations with the user and make suggestions based on what it has ‘observed’. Other key elements are the understanding of scheduling patterns and contextual awareness, which allows the system to anticipate user needs and respond to them in a more sensitive way.
Since the initial presentation of the concept a few years back, Emotech has instead turned their focus to licensing the system’s software (Olly’s brain) to the educational sector, opening up a whole host of new opportunities.
Opportunities for healthcare:
What if mHealth apps had the ability to become more like the patient by taking an empathetic approach; proving encouragement, support and advice that is personal to the individual’s behavioural and emotional patterns over the course of a treatment regimen.
- Could a system understand the level of discomfort of a patient self-injecting from facial expressions, and suggest an alternative technique for next time?
- Could a system detect if a patient wasn’t able to keep up with the pace of video instructions for a medical device through their real-time actions, and automatically slow down or pause the playback?
- Could a system identify the low mood of an eczema sufferer during a flareup through voice inflections or facial expressions, and provide motivation and encouragement for the patient to still attend their scheduled social events?
Responding to user context and condition
AI facial detection system for driver assistance.
As technologies continue to evolve, we are seeing the importance of context awareness in AI, through proactive systems that can detect not only the physical conditioner of the user, but also the environmental conditions and respond accordingly. An industry leading in this area is automotive, which takes a holistic approach to monitoring, by combining biological markers, behavioural biomarkers, and context awareness.
The application of AI in automotive has been evolving at a steady pace over the last decade. Wellbeing, health, and safety continue to be the focal points for these systems; with much earlier applications combining sensing technology from wearables, in-car sensors, and environmental data to initiate driver assistance.
The AI Facial Detection System by Exeros Technologies is an in-vehicle camera system that helps drivers to stay alert by detecting signs of tiredness and distraction while driving. ‘The system continuously scans the driver for signs of fatigue, mobile phone use, smoking and prolonged signs of distraction’, emitting audio alerts to warn drivers of their behaviour and draw attention back to driving. The cleaver system can also send signals to third-party hardware such as GPS tracking devices.
As autonomous vehicles become more mainstream, there will be a greater demand for deeper human-to-machine cooperation. In the not-too-distant future, we may see vehicles with integrated elements of self-driving technology taking control if the driver fails to respond to alerts. Or looking a little further out, seamless switching between driver-control and autonomous mode based on real-time driver and contextual data.
Opportunities for healthcare:
What if digital healthcare applications and devices respond to or anticipate the needs of patients based on a combination of real-time context and state of their condition, creating more tailored and immediate responses.
- Could a system automatically switch been audio and haptic reminders, or alerts based on the ambient noise of the patient’s environment?
- Could a system offer tailored supportive and motivational advice for patients who suffer from anxiety disorders when out in public spaces?
- Could a system monitor a patient using a drug delivery device in real-time and detect potential usage error, creating an alert or intervention to prevent harm or misuse?
Capturing and casting human qualities and attributes
Drawing back to the all-important area of empathy for this last example, it’s worth taking a moment to consider the future of chatbots within the healthcare context. For many, chatbots can be a challenge at the best of times, often creating annoyance and frustration; and for a patient, it’s hard to get any sense of empathy through computer-generated text-based conversations even with a photo of a person hovering in view. Empathy requires a far deeper sensory approach that relies on subtle verbal and non-verbal cues from both parties, to create a connection and a sense of shared feeling.
Perhaps the notion AI with ‘true empathy’ is still a thing best left for the realms of science fiction, for many it encroaches uncomfortably on what defines us as humans. But an area of potential lies in the capturing and casting of the qualities and attribute of real humans through hyper-realistic avatars, such as those created by mobile 3D scanning company, The Scan Truck. Their Digital Human Project saw them team up with interactive content creators ICVR and actor Jason L White to create a hyper-realistic human experience, drawing on the benefits of 3D scanning photogrammetry to create 3D models of a real person.
A good example of a hyper-realistic avatar application can be seen in the financial sector, where, a few years back, investment bank UBS trialled a service utilising human-digital assistants, one of which consisted of a life-like avatar of their Chief Investment Officer in Switzerland, Daniel Kalt. The service allowed customers to book meetings with the digital version of Kalt, which interacted with customers through voice and eye contact. UBS wanted to test ‘acceptance of digital assistants in a wealth management context’, exploring alternative ways to provide their clients with ‘frictionless access’ to their services.
Over the last few years, companies in other sectors have continued to explore the potential of avatars to expand their service offering, creating ‘digital-doubles’ of real personnel in an attempt to create deeper connections with their customers through digital platforms.
Opportunities for healthcare:
Could mHealth apps featured hyper-realistic Healthcare Professional (HCP) avatars based on real healthcare providers, to help guide patients through their treatment regimens and bridge the gap between physical and digital healthcare experiences.
- Could we assign to patients a HCP-avatar of someone from their real-life healthcare team, to create a more personalised and joined-up experience?
- Could we use HCP-avatars to enhance digital mental health services and apps to make them less intimidating and more ‘human’?
- Could we use facial recognition to detect the moods and emotions of patients and elicit an appropriate gestural response from the HCP-avatar to give a sense of real-time understanding?
Greater than the sum of its parts
By taking a wider view of technologies and applications of Emotional AI across sectors, we can learn and leverage the opportunities around behaviour change. By pairing those insights with a deeper understanding of behavioural science, we can also explore numerous opportunities to improve patient adherence in the future of digital healthcare. But ultimately, if the development of healthcare AI is to facilitate a deeper level of connection for patients through digital healthcare systems, a far more holistic approach is needed.
Using Human-Centred Design (HCD) methodology within the development of digital healthcare, allows patient to be put front and centre of innovation. HCD helps to uncovering the unmet needs, desires, and challenges of patients; fuelling the development of solutions that resonate deeply with people and ensuring that digital applications address the wider needs of patients on their treatment journey.
By combining the sensing landscapes (physical metrics, contextual metrics, and emotional metrics), we can start to form a more rounded picture of what is happening to patient not just physiologically but also psychologically; eliciting highly personal responses that balance functional and emotional needs in real time, to create truly patient-centric solutions.
If you would like to hear more about the work we do within the healthcare sector at PDD, you can do so here.
If you would like to learn more or discuss an interesting project with us, get in touch!
How can telehealth enable patient autonomy? A snapshot view of future opportunities
Over the past two years, telehealth has seen exponential growth, accelerated by the pandemic and a need to keep people safe and healthy in their homes. Whilst the use of digital information and communication technology to access healthcare services remotely was something we were already seeing, the pandemic turned this into a necessity, not a luxury; and did so practically overnight.
Interestingly, as our societies start to open up again and despite our move into telehealth being an abrupt one, the return to in-person care has been far more gradual. As we enter the next phase of the pandemic, it is already clear that telehealth is set to stay as people seek to gain and maintain further autonomy and control over their care and wellbeing.
One of the major advantages of telehealth is the broader accessibility to services and the removal of barriers that in-person care can sometimes have. When we look at psychological care, for example, the clinical environment can be somewhat of a deterrent to those seeking treatment. Patients now have the option to receive the care they need from the comfort of their own homes, providing more options and encouraging adherence. As well as the removal of barriers, the convenient nature of this method means it is easier for patients to commit to their sessions and inevitably have better outcomes as a result.
Another benefit of telehealth is the ability to monitor patients with chronic conditions and those who have just undergone hospital procedures. The patient can be monitored remotely, in real time through a smart phone, tablet, or computer and new symptoms or changes in their condition can be reported immediately, rather than risking being overlooked at a next face-to-face check-up. This improvement in at-home care can help reduce the rate of hospital readmissions and transform patient wellbeing for the better. Alongside those advances, online healthcare has also seen an influx of new services and care concepts delivered through digital means. Such an example is ‘eye yoga’, a series of facial exercises and massage techniques aimed at reducing stress and the impact of the vast amount of time we spend on our screens. Trends such as this show the intricate ways in which the consumer is taking onus of their wellbeing and playing an interested and active role.
What we can also see is the autonomous nature of care that telehealth encourages. The relationship between doctor and patient has changed, enabling patients to take a more active role, and fostering a less passive and a more collaborative approach to care. This is a positive shift – it is proven that patients are more engaged with their treatment when it is the result of collaborative discussions rather than something that is dictated to them. We see this self-efficacy exemplified in the growth of smart watches and wearable fitness technology and in how consumers enjoy tracking their own behaviours and health every single day. We can monitor stress, sleep, heart rate, exercise and more- something that has quickly become a norm with companies constantly adding more variables for us to monitor and self-regulate. The rapid uptake of these technologies shows how popular self-monitoring has become in our society – people are continuously seeking out means of quantifying and optimising their lifestyles, including their health, and making it as easily available as possible.
An example of where we have seen one population group benefitting from telehealth for some time, is the use of remote monitoring for expecting mothers – particularly those at risk of any complications. Using a wireless pad and disposable electrode patches, the healthcare professional can monitor the vital signs of the mother and baby remotely – reducing the need for any unnecessary face to face interactions. The patches do not need to be removed at any point, leaving little for the expectant mother to have to do. While the adoption of telehealth services during pregnancy was particularly driven by the risks associated with expectant mothers visiting a hospital during the pandemic, it is quickly becoming part of a holistic approach to pregnancy care, with enormous benefit for those with high-risk pregnancies as they can continue to be closely monitored throughout and in between face-to-face check-ups.
In the near future, as our healthcare systems embrace a hybrid model, we will see more peer-to-peer support incorporated into telehealth, and find new ways to support patients, exploring what they miss the most from frequent, face-to-face interactions.
Yet, despite its obvious strengths, telehealth is not without challenges. Only by putting people at the centre of innovation can we respond to the needs of those patients and medics who use those services or home devices – and aid the development of relevant, commercially successful solutions in an ever-changing world.
Over the last year, connected technologies have become prevalent in healthcare. As the pandemic continues to challenge the capacity of healthcare systems around the world, apps and software-enabled devices have emerged as a tool to provide access, drive patient engagement and secure the continuity of services. Importantly, those technologies have also enabled self-care at a time when visiting a clinic or a hospital has become increasingly difficult for patients.
Beyond those immediate benefits, connected healthcare also opens up new commercial and research opportunities for health services and pharmaceutical and medical device companies. For example, tracking a patient’s treatment on a connected device can provide vital data for researchers to assess the efficacy of medication and the challenges around adherence, both key drivers to improve the health of patients over time. Digital technologies can even enhance the user experience and support a better quality of life for patients, in turn reducing costs and the use of resources in overstretched healthcare systems. Finally, as they become widely adopted, connected devices and the data they generate can underpin public health initiatives and support health data research.
But whilst the benefit of using connected technologies in healthcare is clear, important questions arise. How can we ensure that those technologies continue to be grounded in the real needs of patients and caregivers at a time when they need them most? Is the technology suitable for the intended users – say, for example, elderly patients? How can healthcare IT systems cope with the additional data that new technologies might generate? Who owns the data and who has responsibility for review? Can introducing connectivity in medical devices increase the risk for use errors in new ways?
Technology for a better treatment experience
Digital technologies can be a great ally when it comes to improving adherence and uptake of treatment. When adding digital functionality to an existing medical device to remind a patient to administer or track their treatment, we lower the burden on the individual and set the basis for a better treatment experience. This approach is particularly beneficial in the management of complex conditions where the treatment burden is high, like Cystic Fibrosis in children.
Children with Cystic Fibrosis can spend a large portion of their day on their care regime. This impedes adherence, adding considerable strain to both the child and their caregiver and making for an unpleasant and stressful treatment experience. Playphysio is a free app for smartphone that, working in combination with myPhysioPal – a small device that connects to a patient’s respiratory physiotherapy system, adds a gamification element to the treatment. By counting their blows, and by reminding patients to change position and carry out clearance exercises, Playphysio encourages children to complete their respiratory therapy while they play games similar to ‘space invaders’ with their physiotherapy device. Designed with the needs of children in mind, it increases engagement and offers a welcome distraction during treatment. Technologies like Playphysio can improve adherence and provide great health benefits in the long term by enhancing the quality of life for patients and their families.
But designing technologies that work for children and families is not straightforward, as each user group tends to have different expectations in terms of what the device can achieve and what it should do for them. Children might, for example, want to feel empowered and in control of their own treatment with a system that gives them some form of independence. Caregivers – parents, guardians, grandparents – on the other hand, might prefer a device that allows a degree of supervision and gives feedback on whether the treatment is being done correctly so that they can monitor their child’s condition and intervene, if necessary.
Healthcare innovation often exists within these complex systems, where multiple users and stakeholders have different needs and expectations. With new digital technologies, we need to consider the needs of each individual user, ideally by liaising directly with them to remove any incorrect assumptions that might exist.
The shock of the new
As we acknowledge the value of connectivity in healthcare, it is worth noting that adding new technology components to an existing device can result in additional costs, more complexity, and an increased potential for use errors. We must also remember that new technology features typically take the shape of an additional physical product that people have to store, carry, and remember to have with them; and consider the difficulties that this might present for users.
We also need to recognise that the value of technology in the earlier stages of healthcare product development can be difficult to assess. As we progress with user research and testing, it is not uncommon for features that initially seemed attractive to be proven less relevant or helpful. This is why however enticing connected technologies might be, we must stay grounded on real user needs and be mindful not to overestimate their benefits. At the same time, we must take into account the wider context of use within our healthcare systems to ensure that any critical requirements in terms of types of data or communication pathways are addressed early in the process.
In terms of safety, the product’s medical intention must remain the priority and we need to ensure that new technologies do not add any unnecessary risks. If the intention of a product is to administer a drug, that intention should not become secondary to other features brought on by connectivity, such as the recording of the drug administration on an app. It is also important to avoid adding unnecessary steps to the user experience which might add some risk and potentially reduce the overall safety and effectiveness of the product.
Lastly, in our efforts to make a connected healthcare product more engaging and appealing, the use of semantics raises some questions. For example, toning down the medical aspects of the product might help reduce treatment stigma and fit a patient’s lifestyle; however, in doing so we might risk losing clarity around the product’s medical purpose and creating a potential safety concern around misuse.
A systems approach
As we have seen in the examples above, new technologies in healthcare always work as part of broader, interconnected systems and we should always consider their wider implications. Technology advances could lead, for example, to reduced interaction between healthcare professionals and patients. As designers and innovators, we must be aware of those shifts and assess any unintended consequences that might affect patient care.
Context of use is also important. Take, for example, the role of community nurses. They are amongst the health professionals that would benefit most from real-time patient information, yet they are rarely sitting behind their desk. How can technology-enabled devices support their workflow and the care for patients in a decentralised system?
Crucially, as new information systems rely on the effective transfer of data between patients and caregivers, they inevitably demand a higher level of data entry. This could potentially add to the pressure and workload of already-stretched healthcare professionals. The restricted use of data in healthcare environments, with strict firewalls and compliance protocols to protect patient confidentiality might further limit the opportunities for effective data transfer and add to the barriers of entry for new healthcare information technologies.
The successful adoption of technology is rarely driven by what that technology can do, but by how people interact with it and perceive its benefits. This is particularly true in healthcare.
Trust and perception are critical in ways that can be hard to make explicit. Age, background, physical and cognitive abilities and socio-cultural influences will significantly affect a patient’s willingness to interact with a new device.
As connected technologies continue to permeate healthcare environments and patients continue to take a more active role in the decisions around their health, keeping users at the centre of medical device development is more imperative than ever. Only then will we be able to develop tech-enabled products that are appealing, improve quality of care and maintain the integrity, safety and effectiveness of our healthcare systems.
In recent years, wearables have started to play a pivotal role in the lives of patients. From the management of chronic conditions to making sure that we drink enough water, wearable and mobile devices are revolutionising the way that healthcare occurs.
Wearables can improve the lives of patients and caregivers and, crucially, in the context of the current pandemic, reduce the burden on healthcare systems at a time when they are most stretched.
From smart textiles to electronic tattoos, the increased use of wearables in healthcare has been driven partly by remarkable developments in technology. These range from leading-edge advances, like augmented reality and body-powered devices to traditional products like watches or GPS devices, adapted and repurposed to provide new capabilities.
But the change has also been underpinned by the fact that people are increasingly willing to share their health data, and take an active role when it comes to staying healthy. Tools like GPS tracking, and activity and heart rate/oxygen saturation level monitoring increase people’s ability to self-manage conditions, and can support disease prevention. Such tools can also be used for remote diagnosis and collect data in a way that was hitherto not possible.
In this article, we will look at the current and new wearable technologies that are emerging in the context of COVID-19, and what they might mean for the future of healthcare and the prevention and management of chronic conditions. Lastly, we will tackle one of the biggest challenges ahead – how to test and validate the use of wearable devices successfully in the context of clinical healthcare settings.
Wearables and digital healthcare in the context of COVID-19
Earlier this year, a piece of research conducted by the International Data Corporation in light of the new coronavirus predicted a 30% increase in sales of health wearables in 2020, due to consumers’ increased interest in their own health. At the same time, opportunities for new product development are opening up with a range of technologies that lend themselves to varying forms of infection control.
One example is Immutouch – a smart band that vibrates when users touch their face, potentially preventing them from catching diseases. After downloading the Immutouch app, the band can be calibrated by bringing the hand closer to the face, which will cause the device to vibrate, thanks to a gravimeter placed inside that uses a personalised algorithm.
This type of solution may be helpful for those working in a front-line role. It can also provide potential benefit to those working in customer-facing industries like retail, manufacturing and public transport.
Another example is VivaLNK’s Continuous Temperature Sensor patch, designed for remote, 24-hour monitoring of axillary body temperature. This type of solution has a broad purpose – it could provide a monitoring tool for those who are undergoing immunosuppressive treatments and could also support the conduct of clinical trials. The product range employs an eSkinTM Technology which is a breathable film substrate with integrated sensors and circuits. This illustrates one of the big advances in this field – the shrinking of sensing technology means that it can be worn for increasing amounts of time, enabling new applications.
Digital tools can also help when the goal is to provide public health information or to respond to requests for information. For instance, the Japanese chatbot Bebot supports crisis workers by giving members of the public instant information about COVID-19. The chatbot doesn’t require an app and pops up offering clear information in multiple languages to people visiting Japan, as soon as they connect to a public Wi-Fi.
Both within and beyond the current crisis, wearable technologies have the potential to profoundly impact our lives and support decision-making. In a way, it is about relaying information back to the user as well as recording information from them.
For example, Mojo provides smart contact lenses with built-in displays. Created by optometrists, medical experts, and technologists, Mojo lenses can help users access important notes without the distraction of a mobile device.
The lenses also display health-related information, such as heart rate, and navigation and sight-enhancement features. Within the current crisis, the benefit of this type of technology is that it can support communication without the need to touch an interface or mobile device.
Wearables in the context of chronic conditions
Whilst our immediate focus may be on COVID-19, there is a bigger picture in terms of managing and reducing the occurrence of long-term and chronic conditions. This type of condition accounts for the majority of healthcare spend and can be a significant risk factor in COVID-19-related hospitalisation.
Wearable technologies can prevent, reduce or delay the exacerbation of chronic conditions through real-time monitoring. The use of wearable devices means that symptoms can be picked up earlier, and that patients can monitor their own health and capture data to aid physicians in their treatment and prevention plans.
Good examples are wearable technologies that monitor someone’s activity, with monitors and smart watches becoming increasingly popular.
Being active plays a major role in the reduction of risk for many chronic conditions, and the use of wearable devices have been shown to reduce sedentary behaviour and improve overall wellness. In both the UK and the US, schemes have been rolled out that provide incentives to encourage patients to hit their daily step count and activity levels; factors which contribute significantly to chronic disease prevention such as obesity and diabetes. Such incentives can be in the form of vouchers or discounts, or funding towards health insurance. This incentive model can encourage people to remain active and reduce the risk of those susceptible to certain chronic conditions.
Monitoring through wearables also facilitates shared decision-making between patients and healthcare professionals, and is a valuable tool to promote adherence and compliance.
Enabling patients to monitor and potentially improve a chronic condition through tools such as wearables gives them a greater sense of control and empowerment.
Continuous glucose monitors are a perfect example of how a wearable can reduce the burden and increase the level of monitoring. With the device constantly tracking glucose levels throughout the day and night, an app can notify the patient of highs and lows. Patients are therefore provided with a clear image of their blood sugar levels without them needing to carry out regular finger-prick testing.
As the device allows continuous monitoring throughout the night, they are provided with a higher volume of data and therefore more consistent monitoring of their blood sugars in a way that would not have been previously possible.
Benefits are not limited to glucose monitoring – for some conditions such as Alzheimer’s and Dementia, simple wearables with real-time mapping, voice systems and the ability to activate an emergency call can greatly increase a patient’s independence and reduce the burden on their caregiver.
By being able to track a patient during their walk and communicate with them if necessary, their risks are reduced and the patient is provided with freedom for an extended period of time (i.e. they can be alone if they want to).
Some chronic conditions may be less obvious – for example, those that are at risk of heart disease can benefit from something as simple as a step counter.
As technology moves on, there is potential to integrate multiple sensors and leverage existing platforms, such as phones to develop a rich picture of, for example, the link between cardiac health and lifestyle. With this understanding, appropriate interventions can be targeted accordingly.
It is becoming increasingly clear that there is a lot of potential in wearables in terms of pre-empting and proactively managing chronic conditions, as well as managing and mitigating the impact of COVID-19.
In a healthcare setting, there are additional advantages to the use of wearable technologies, including:
- Supporting condition management – i.e. wearable devices can contain sensors that allow for tailoring of support and treatment.
- Supporting the move to a pre-emptive model of healthcare – for example, by helping people to look after themselves and avoiding more significant interventions such as surgery. Wearables can also form part of a behaviour change approach that promotes a healthy lifestyle.
- Improving outcomes, by collecting data in a way that was not previously possible (e.g. home use body-worn ECG monitors).
- Engaging communities. One of the great things about wearables is that they allow for “maker” communities – working in hackspaces, with open source tools that share ideas in an interdisciplinary setting – to come together and approach a challenge from a fresh perspective.
Yet, with those advantages come some challenges, particularly when testing those devices in the context of traditional R&D models. In the last section of this article, we consider how such potential can be measured and demonstrated.
Testing wearables – what works best?
By definition, wearables are part of a broader system which means that collecting feedback is inherently contextual and distributed. What’s more, wearables typically involve attaching objects to people, a process that always requires careful consideration. For example, trials of systems that use an adhesive to attach wearable devices to the body reported instances of transient skin irritation in 2.7% of people. There is a large body of literature around MARSI (Medical Adhesive-Related Skin Injury) and a need to carefully consider the impact of extended wear periods.
Given the complexity of designing wearable systems, here are some suggestions as to how to get the best value out of them:
We need to adopt an interdisciplinary approach
Wearables combine different forms of technology. Take, for example, a body-worn sensor. In bringing a solution to market there would be considerations around the shape, size, method of attachment, etc. There would also be considerations around the internal components, the suitability of the sensing technology and a range of options around batteries and connectivity. The approach to testing will therefore need to take all of these factors into account and borrow learnings from other industries (sporting, military, etc.) – we need to think broadly.
We need to test in context
It goes without saying that when testing this technology, we need to take into account the complexities of everyday life, such as how technology is carried around and how it impacts on work life, social interactions, etc. This is hard to do in a simulated context, or in a market research facility because we don’t capture the full range of factors associated with real-world use. In these cases, a different type of approach is required where we use ethnography or contextual inquiry; or where, instead of a moderated study, data is collected through diaries or notes.
We need to collect feedback over extended periods of time
Something we want to avoid with wearable technology is people taking the device off. If that happens, the benefit of the technology has been lost. Although there are many ways of testing healthcare-related technologies, not that many of them consider extended periods of time, nor adopt a longitudinal approach or time-series data. This is particularly important as it is not uncommon for there to be an initial period of engagement to be followed by a fall-off in the use of a given technology. Therefore if the test window is short, we may miss important things. The longer a candidate technology is used, the more likely we are to find out what may impact on the acceptance of it. This requires the use of a new type of extended trial design.
We need to consider data analytics during the design and development process
Wearables often collect data. How this data is used is an important part of the process and there is benefit in terms of being clear about this at the outset.
There is a balance between too much and too little data, e.g. it can be helpful to know what you want to get out of a sensing technology and avoid throwing everything at a given problem.
We need to work within an underpinning framework
In the same way, there will be a need to fine tune some of the algorithms that will form the basis of the technology, there may also be a need to understand why a device does or does not provide the desired effect. Although this may be debatable – some might say that if something works, then who cares why – with wearable technologies, we need to adopt a theory-driven approach.
Whereas previously our interest would have been on whether someone can use a device – now we are also interested in aspects around continued use, co-evolution and effective adaption of intervention content to changes in technology.
PDD is exploring wirelessly-connected drug delivery systems alongside the use of digital apps and sensors to improve patient experience and condition management. We are also developing algorithms that can determine if people are compliant with this type of technology. For example, sensors that can be worn on the patient’s body detecting movements continuously on a 24/7 basis.
Although there are many off-the-shelf solutions which fulfil the need from a technical perspective, customised solutions can offer many benefits especially in light of comfort, compliance and long-term wear. We can therefore use sensors not only to determine aspects around lifestyle but also to understand the suitability of alternative solutions and the extent to which users are prepared to keep them attached for extended periods of time.
In recent months at PDD, we have developed our own innovations in terms of attachment, including adhesives and materials research to find a solution that can be as unobtrusive as possible. Our work included the research of current designs and off-the-shelf options, concept development, refinement and visualisation, early-stage modelling and two stages of user testing. The solution adds value in allowing for long term use and wear, improved compliance and rich data whilst being minimally apparent to the user.
With wearables becoming more popular within healthcare we need to remember that they will be used by a wide range of users from those who are digitally literate to those who are technology averse. Therefore, it is important to consider and research the varying user needs to ensure that what is developed fits a variety of user profiles.
At the same time, we need to consider aspects relating to data protection and privacy. Given the amount of data that is available through the use of wearables and the complexities relating to data storage, consent and management – there is a need to adopt a carefully designed process to research and development.
The road ahead might be complex, however, the opportunity for wearables to have a positive impact in our healthcare ecosystem in the long term is well worth the investment.
Mobile phone software applications are a ubiquitous part of society. In 2018, there were estimated to be 205.4 billion smartphone health app downloads (worldwide). In 2021, this figure is expected to rise to over 352.9 billion. The adoption of digital tools to track and improve health is a big part of this trend and offers the potential to minimise the cost of care and reduce the chances of suffering from a disease.
In this piece, we explore some of the recent innovations in this area and consider how they will make a difference. Healthcare gadgets are enabling us to take control by monitoring our lifestyle and storing health records. With modern technology this burden can be reduced, placing data tracking tools under an increasingly favourable light.
Artificial Intelligence (AI) has long been a topic of interest across the tech industry and it will continue to prove useful within the healthcare context by streamlining administrative and clinical processes. Because AI applications cannot yet make clinical decisions, they can be used to improve staff productivity and make back end processes more efficient. According to Accenture analysis, several major applications are set to reshape the healthcare sector by 2026.
As illustrated above, each application has an associated value and the higher the value the more likely implementation becomes. Hence, robotics is likely to become prevalent and offer new capabilities (for example incorporation of information from medical records during operations in real-time). This analysis also forecasts that virtual nurses will become another frontrunner – AI applications will allow users to have their symptoms checked remotely and results sent to clinicians only when patient care is required, avoiding unnecessary visits to hospitals.
What do tech giants have in store for healthcare?
By combining data stored on mobile phones with health records from multiple institutions, Apple is generating a holistic overview of user health. Apart from allergies and medications, users can also access details about their own mental health, which are generated through changes in screen time or drop-offs in social interaction. Eventually, users are notified and alerted to address such issues. Technology is, therefore, serving as a way of understanding personal wellbeing.
Image credit: Apple
At the same time, binge-watching TV shows, replying to work emails and catching up on the latest social media posts might not lead to a balanced life (for example overuse of technology could lead to sleep deprivation and/or a disturbed sleep-wake cycle). Researchers suggest that poor sleep is related to the risk of cardiovascular disease (for example). However, technology can be used to address this concern – for example, sleep tracking devices might help diagnose when sleep patterns are unusual and/or flag issues. For instance, the sleep tracking app Urbandroid was developed for Android users and monitors sleep. The awake-detection process is depended on users’ sleep phases, heart rate and movement patterns. It uses Philips Smart Light to wake them up at an optimal time, therefore, facilitating sleep quality.
Image credit: Urbandroid
Good quality sleep is regarded as beneficial as it can help users lower their anxiety and feel refreshed and rested. Wearables can also play a role in this – offering personalised suggestions on how to improve health. Reviews suggest that the latest addition to Fitbit’s charge generation – Fitbit Charge3 smartwatch will place the brand at the top of the list for smart wearable devices.
Across many applications, customers are increasingly looking towards technology-mediated support. For example the emergence of autonomous and internet-enabled appliances ready to provide nutritional advice adjusted to individual need. Innovative fridges, such as Samsung’s Family Hub™ Multi-door Fridge Freezer incorporate a recipe app, inner view cameras and shopping reminders into a kitchen appliance – ready to feed the appetite of the health-conscious consumers.
Image credit: Samsung
With this array of modern technology, unhealthy living will hopefully become a thing of the past especially with the emergence of autonomous and internet-enabled gadgets ready to assess your performance and provide suggestions for improvement based on your lifestyle. Nevertheless, it is still to be established whether wearable devices will ever replace doctors; and not because they are lacking in precision or information, but because the social interaction between patients and the medical staff goes beyond sensors and a smart screen.
Chris Vincent, Principal Consultant for Human Factors & Ergonomics at PDD, took part in the conversation on beta testing for medical devices at the Human Factors for Medical Devices workshop which took place at the Museum of London earlier this June.
The initial use of the term beta can be traced back to the 1950s when IBM started to test product ideas and theories categorised as ‘A’ and ‘B’, which later become widely-known as ‘alpha’ and ‘beta’. Commonly used by companies to find issues prior to release, beta tests provide for quality improvement and smooth usage of products. This terminology is not typically applied for medical devices but could become relevant as medical devices incorporate increasing amounts of software and graphical user interfaces.
Following his professional experience and background in both healthcare and aviation equipment optimisation, Chris led a discussion on how beta testing is connected to medical devices and the issues that safety critical systems are currently facing. The talk also covered the audience’s views on how test and evaluation strategies can be best implemented and implications relating to patient experience and wellbeing.
Human Factors plays an essential role within our business operations and we are passionate about understanding the usability, human capabilities and cognitive psychology behind all the innovations we are proposing and designing.
Learn more about Chris’ work and our experience in Human Factors and Healthcare at https://pddenglish.wpenginepowered.com
PDD’s Graham Lacy attended the Digital Health and Wearable Technology Shows at Excel.
This twinned exhibition showcases recent innovations in connected devices for the healthcare and wellness industry as well as wearable technologies from other categories.
Many of the new devices were simple bio-sensors taken from previous ‘wearable technology’ form factors of limb bands (wrists on 2-legged mammals and necks on 4-legged) providing real-time monitoring of health, wellness and whereabouts.
Devices were either at the sensing or giving end of communication and these shared a common aim to minimise physiological burden. Amongst the sensors were other ‘jewellery’ formats such as rings and pendants as well as textile and in-clothing forms.
At the other extreme, RIVR in co-operation with the Leicestershire Fire and Rescue Service, showed how much physical technology can be worn with purposeful effect. Donning a powerful, graphics-accelerated laptop in backpack form, a VR headset and holding a teleporter hand control, they demonstrated a training aid for the forensic examination of fires. In another training exercise, and wearing a first responder respirator (coincidentally designed by PDD), breathing apparatus and protective clothing, fire crews were given an even greater level of simulation of the real-world wearables.