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.
Posted by Marlies Havenith
Senior Consultant – Human Factors & Usability
Dutch and English
The last thing that inspired me: The response and resilience of medical staff during the COVID-19 pandemic
My dream project: To flip my own house
My obsession: My little miniature shnauzer puppy
Image credit Image credits: Comic Relief/Playphysio