Bridge Design

Evans writes about the use of gaming industry technology to create new ways of guiding surgeons and interventionists to their quarry, with companies like SuperDimension leading the way. He also discusses our prediction that as electronic medical records (EMRs) become more widespread, there will be a greater possibility of smarter devices that will act independently according to the patient’s medical history, in addition to what the sensors are reading.

Click here to read the full article.

This article reflects Bridge’s more general approach to design thinking – we are always on the lookout for general trends in technology that will have a potential impact on medical product design.  Evans recently returned from a trip to the UK and noted a couple of trends in Europe that are slightly ahead of the U.S. that could eventually find their way into medical products.

First, an example with interesting potential in chronic disease management is a new cell phone-enabled technology on sale in the UK by O2 (a large carrier) called the Joggler. It’s a family-oriented “central” organizer (think a touch screen family calendar you keep on the fridge door). It is inexpensive and serves as a way of coordinating family activities by texting reminders to all family members and generally being a place to keep common family information.  It has a large touch screen, is video capable and is rumored to allow third-party apps to run on it.

Above: The Joggler

Imagine the power of this kind of network-connected appliance that is also connected to you personal cell phone or personal healthcare device in the future.  Applications could be created that become a central place for current information about your health to be stored, text reminders could be sent to your cell phone, your doctor could get monthly reports or be notified about exceptional events triggered by readings from your personal monitors.  When more of these personal health monitors (such as BG meters, pill containers, inhalers, etc.) start talking to each other, this could be a boon to managing chronic conditions such as diabetes, asthma or COPD, obesity etc. where a combination of monitoring compliance or reporting diagnostics could be more powerfully and transparently coordinated.  No need to worry about inputting it to your computer or even bothering to have an internet connection with difficult-to-set-up WiFi connectivity.  The always-on cell link could look after that.

Another interesting trend noted on the same UK trip was a way of making print advertisements more interactive that could have interesting medical applications.  Some innovative marketers have added 2D bar codes to their print ads that are readable with a regular cell phone camera.  The idea, seen on a Volvo car ad in the Guardian Newspaper, is that users snap an image of the small 2D bar code. Because of a previously-installed generic app, the phone knows where to send the bar code and the cell-phone user then gets a link to a video sent to them by return, in this case a video showing a Volvo ad.

What Bill found interesting about this idea is that if this technology takes off, it could become an interesting way of expanding the way in which people with various conditions monitor and manage their health. For instance, Advair inhaler users are supposed to note the exact day they open their inhaler package and stop using it after 30 days, due to its shelf life once opened. Who actually does this?

Instead, if the packaging had this bar code printed on it the user could just snap a photo and 30 days later, they’d get a text saying it was time to open a new one.  Imagine if all foods began carrying this bar code and it was linked via web site to help you manage calorie intake for dieting or carbohydrate intake for people with diabetes. How many users bother to read those obscure, icon-laden instructions for use (IFUs)?  What if the packaging for that complex device had this 2D barcode: the healthcare professionals could photograph it on their iPhone camera and then immediately see a short IFU video in their local language that shows them in better-animated terms how to correctly use it?

Bill put together a short list of directions for how to do this yourself:

First, download the free “scanbuy” app to your phone (we tested it on an iPhone but it’s also available to many other phones) from scanlife. You must have this app on your phone for it to work.

Next, aim your camera phone at one of the barcodes below on the computer screen. The first bar code will lead your phone web browser to the Bridge Design blog; the second one will lead to a video demonstration of how to use a product we designed, Cleo (you’ll need to click through on the video to run it). The bar code will work from print, computer, and television. Take a picture.

Above: Cleo video 2-D bar code

Bridge 2-D bar code

Did it take you to our website blog, or to the video? The possibilities are enormous — get on with applying it!

One of the larger trends we are seeing is that some of the thinking behind what makes a great consumer product is finding its way into forming medical products, especially those that are very patient-centric in their use.  Nowhere is this more obvious than in application specific products where we have an opportunity to design for a much more specific group of users, the product can be designed for a much better patient experience without the need to be all-things to all users like many of the general medical products out there.  To give an example of this trend and be able to show it now the Bridge ID team designed our interpretation of what an ultrasound device could be like in the near future.  Our press release below.

San Francisco – April 6, 2009 – Bridge Design, Inc. - Portability is the fastest growing segment in the ultrasound market. Imagine fast-forwarding a few years when technology becomes less expensive and more powerful and compact. What would a birthing-specific ultrasound, designed specifically for the mother–to-be, look like?San Francisco-based Bridge Design has come up with an innovative, mother-centric device that focuses on making the ultrasound experience pleasant and hassle-free. The Stork provides a number of features not yet on the market, including a second display so the mother won’t have to strain her neck to look at the screen. It also allows the mother to email electronic images directly to family and friends from the device instead of receiving paper printouts. Unlike the average ultrasound machine, the Stork is unintimidating, even playful, with a flip screen and basket-like portability which contains “cup holders” for probe and gel. The Stork’s color, materials, and finishes forgo the clinical white and gray palette for a much more soothing birthing experience.Bridge’s Director of Industrial Design, Matt Presta, who also happens to be a parent, explains:“Any mother who has had an ultrasound is familiar with the cart of equipment, probes, gels, screens, printouts, and everything else that comes with it. And although the experience is necessary for clinical reasons, many parents just want to see their baby. For years, Bridge has observed trends clearly pointing towards designing for the patient’s experience. Since we’re still a few years away from seeing the tipping point of the patient-centric trend in health care, we wanted to provide a glimpse into the future based on what we’re seeing happening in the industry.”It’s worth noting that although this device has not yet been manufactured it reflects a trend that Bridge sees growing, with more application-specific medical products likely to appear at healthcare facilities in the not-too-distant future. “As a given technology matures, its cost and size typically shrinks. This opens up exciting possibilities to those forward-thinking medical equipment manufacturers who understand that if you change your design thinking to be more user and patient-centric, then new market opportunities can be created. Addressing baseline functionality and reliability at low cost is not enough to stay ahead of the game in mature markets,” says Presta.

A description of services can be found at http://www.bridgedesign.com.  SOURCE Bridge Design, Inc.  Contact Matt Presta of Bridge Design, Inc. +1-415-487-7100, ext 300, mpresta@bridgedesign.com

savvy medical device manufacturers.  In the cross-functional development teams that create such products, industrial designers may possess the skills and enthusiasm that can deliver these qualities. 

Thus, industrial design is now integrated into the development process of many medical manufacturers. Similarly, OEMs that understand their users as well as the broader trends in the consumer marketplace, and then tailor their products to them, are often the most successful.

In an increasingly competitive landscape, medical product developers that want to try to stay ahead of the pack are turning to industrial design to accomplish that goal. OEMs need to know how their development teams can best harness industrial design for a particular product. It is also essential for OEMs to be aware of the design trends to watch in the coming decade.

Defining the Product: A Customer-Focused Approach
Through surveys at many medical industry forums, I conducted an informal poll. I asked project managers and design engineers to rank the issues that most interfere with getting a high-quality product to market quickly. The number-one answer was “difficulty of defining the product.” “Resourcing” and “corporate culture” followed closely behind.

Nowadays, it is not good enough to just build a product that is technically superior to or less expensive than competitor’s. It must stand out from the competition on all levels. And it must give customers a compelling reason to change their buying habits or to choose to do a new medical procedure. Getting the development team out into the field to interact with potential customers is the best way to begin to define the product and eventually win market share.

OEMs often call upon industrial designers to use their people skills to better understand the subtleties of customer needs. Industrial designers are good at using their visualization skills and their understanding of multiple disciplines to generate ideas for a development team, acting as agents of change.

There are many ways to integrate a more-customer-focused approach into a design process. The cost of doing so can range from hundreds of dollars, to send members of the design team to a specialized medical academy meeting, to hundreds of thousands of dollars, to conduct in-depth market research.

It’s beyond the scope of this article to delve into all of the available methodologies.  Suffice it to say that the best methods, whether large or small scale, all have basic attributes that can be summed up as call and response.

Call. The team calls out to users and customers to find out how they work, what trends affect their work, and what they want most from a potential new product offering. Sometimes companies gather this information by large-scale qualitative or quantitative surveys. For maximum benefit, members of the design team should have opportunities to participate in the data-gathering process.

Team members should view potential customers actually at work. Industrial designers often are good at this field research.  With a combination of experience and motivation, they can provide a designer’s perspective on the market.  They can often spot opportunities that a focus group analysis might miss.  

It’s important to remember that customers often say they do one thing when observation shows that they really do something different. In such situations, thelead investigator should be as impartial as possible, but participation from the development team should be as broad as possible.

A firm may consider hiring professional facilitators skilled at leading observational research if it can afford them. But it is also important to understand that industrial designers can be impartial enough to be the lead researchers early in the development process.  At that time, they won’t have begun their owndesign work or become committed to their own ideas.

For instance, imagine nurses who are responsible for accurately dispensing potentially dangerous painkillers. A researcher can interview them afterhours in a peaceful environment, or talk to them as they walk the hospital floor. Although the same facts might be conveyed in either environment, the researcher who follows the nurses around during their duties may notice that interruptions constantly demand portions of the nurses’ attention.  Awareness of the nurses’ distracting environment may help designers simplify and clarify the user interface of the drug-dispensing equipment to reduce the potential for errors.

Industrial designers can also add value to these early feedback sessions by conducting product visualizations. Sketches of loosely formed product concepts, whether computer or hand generated, are the forte of the industrial designer. By capturing a long list of potential product features in only a few storyboards, designers can convey ideas very quickly. This activity is also aided by the fact that industrial designers usually have good cross-disciplinary understanding, so they are capable of combining input from many different specialties to produce visuals that everyone can understand.

These illustrations can be shown to potential users to gauge their enthusiasm for overall ideas or features. However, the beginning of the user research sessions is not the time to introduce new product ideas. This stage should focus on information-gathering conversations, and introducing new ideas may lead subjects astray. In some cases, it’s best to simply listen and observe. Sometimes, however, adding a few storyboards at the end of the session can help steer the team more effectively in the next phase, the response.

Response. The team takes what it has learned in the field and synthesizes the data into some whole product concepts. There are many ways to use field research to stimulate the team brainstorming process.1 It is most important to use techniques that remove personal bias from the concepts the team creates.  Use some method of ranking customer input so that the concept-generating phase focuses on the market’s top concerns.  This phase should also bring about a thorough understanding of the competitive landscape by benchmarking the device’s competitors.

Industrial designers can then take the team input and turn it into high-level product visuals. The designers can quickly simulate ideas with physical or virtual models that otherwise might take months or years to refine into actual products.  

However, some caution is required.  On one hand, because industrial designers are not the ones implementing the product modifications, they do not need to be sure that their concepts fit within real-world project constraints. But on the other hand, separation from the implementation details can give designers an important role as agents of change.  For instance, a team may not want to suggest a new display and user interface for a diagnostic product because of cost issues. An industrial designer might look at trends in other markets, the availability of inexpensive color displays, and rising customer expectations of ease of use.  With such data, designers could make the case that an improved display is an essential addition to ensure that the product remains competitive.

Certainly, these ideas can be taken back out into the field for further review with customers. But again some caution is needed, especially in areas where the development team intends to apply more-revolutionary or so called disruptive technologies rather than evolutionary concepts.2 Customers can often judge how a new product will be received if the changes improve upon a product or procedure that already exists. But it is much harder to get feedback on products that require users to imagine a different way of doing their job or treating a patient.  Analyze any rejections or acceptances in light of the qualitative data collected about specific customer needs.

The Value of Bringing in Outsiders
Outside designers can bring a fresh perspective and dramatically different ways of solving a product development problem. Of course, if it’s not done right, outsourcing design can lead to some irresponsible approaches and impractical suggestions. Negotiating this risk is at the heart of the decision whether to outsource industrial design.  The solution lies in getting the right balance into the development team. Depending on the product, doing so may entail drawing entirely from within the company, bringing in industrial design consultants, or a combination of both.

Within a team, the wisdom of experience needs to be tempered with fresh thinking. The newcomers must not be afraid to challenge the status quo, but should respect the knowledge gained from those with in-depth product design experience.

If a company’s products have always followed one course of development but begin to face new threats in market, then it is probably time to bring in outsiders. But if the firm has a consistent track record of innovation, then in-house industrial designers are more likely to be able to thrive.

Smaller medical OEMs frequently bring in design consultants, because they often do not have enough work to justify hiring highly skilled full-time players.  As a rule of thumb, one experienced in-house designer in the device industry can probably handle four significant projects a year. Of course, much depends on the type of product and depth of industrial design involvement.  No matter how industrial design is brought into the team, the designers should not have to report to any one discipline. Rather, they should be responsible to the whole team.

Above all, it’s important to remember that it does not have to cost a fortune to use industrial design. Any amount of customer contact is better than none; even a little industrial design early in the development process can go a long way toward improving the product.

Design-Trend Market Pressures over the Next Decade
Increasing Expectations of Improved Standards of Care. More and more, patients are directing important decisions that affect their own care. Although medical professionals still make many treatment decisions, patients are becoming better informed about alternative treatments or locations for care.  For instance, many expectant mothers now choose the facility where they will have a baby. As a result, many birth centers employ products that will make the whole experience much more enjoyable, personal, and friendly. Many medical devices are employed to deliver a baby, and manufacturers that tailor their products to make them less austere or intimidating will do well in this transforming market.

Also, many procedures that were done in a hospital are moving to lower cost surgical centers or doctors’ offices. Equipment designers must respond to opportunities and challenges created by this shift. This is especially true when the procedure is elective or has a lot of competition. Industrial designers’ skills at improving both doctor and patient ergonomics can make a procedure go more smoothly. Creating a product that looks appropriate and approachable will also improve the experience for both operators and patients.

Sometimes OEMs forget that doctors and patients are also consumers in the general marketplace, and these consumers are learning to love good design there. If a doctor can read a wireless portable e-mail device’s color screen in direct sunlight, why should it be a struggle to read a low-contrast monochrome display on an expensive surgical control console? It is no surprise that patients listening to a thin mp3 player or answering a tiny cellular phone think that their ambulatory medical device restricts their lifestyle.  Medical consumers will reject clunky products, preferring better-designed devices instead.

Appropriate Design for Developing Nations’ Medical Needs. Although developing countries’ healthcare needs are often basic and immediate, they still pose interesting design challenges. The key in designing products for such nations is to be culturally appropriate and toavoid imposing developed nations’ biases. For example, large swaths of Africa and Asia completely missed the wired era of telephone evolution. They instead jumped straight to the latest in cell phone technology, which created demand for ultrasimple low-cost phones.  

Using Design to Benefit from New Opportunities
Making Change Easier. The path to innovative new procedures or products is littered with projects that had significant improvements, but lacked some key element. The missing piece can sometimes be restored with the help of an industrial designer’s contribution.  A good designer will dig into the question, asking, “What design qualities will give customers a compelling reason to change from their current ways?” Relying on pure technical prowess or even an improved outcome will not always work; the broader aspects of a product’s features must be simultaneously addressed.

Sometimes integrating human factors will ease adoption, but if it is done poorly, it could as easily doom a product. Sometimes simply making a product less intimidating in appearance will affect customers’ perceptions. Sometimes a designer’s human factors skills can go a long way toward improving usability.

Integrated Medical Information Systems. Integrated systems have gotten a lot of press lately, though in practice, adoption by hospitals has been slow. Many such systems still need to overcome the problems of inputting and accessing the healthcare information generated by many different systems.

Clearly, once the systems are more broadly implemented and there is agreement on data formats, a new generation of devices will emerge. Designers skilled in solving the challenges of userinterface design will play an important role in making this information-rich environment easier to navigate. For instance, a patient monitor might be able to combine data from its own sensors with risk factors in the patient’s medical records to determine the probability of a serious adverse event.  Rather than just raising a simple alarm, there will likely be a better system for alerting and presenting this information.  It will allow urgent medical care to be given effectively at a stressful and potentially error-prone time.

Design as Part of an Integrated Marketing Strategy
Industrial designers’ problem-solving skills can help medical device OEMs improve their products. But there is another subtle aspect to industrial design that can help a company stand out in a crowded marketplace. The look of a company’s products across its whole product range is a very effective business tool that reinforces and increases customer awareness of a brand. This look is sometimes called design language.  It is commonly used by consumer product companies whose products present a consistent image.Design language goes above and beyond product graphics, packaging, and advertising. When customer loyalty is built in one specialty area, it can cross over into others and affect buying habits. Savvy medical companies can leverage their marketing and advertising dollars by having a consistent brand look.

For example, consider the many instruments, both diagnostic and therapeutic, that often sit outside operating rooms or in hospital halls. This impromptu display is a great opportunity to make sure that people recognize a brand and see that it has passed muster with the purchasing committee. (Incidentally, this is also a good reason to make sure the products weather well in the tough hospital environment.)

Conclusion: The Way Forward
If industrial design is not currently being used effectively within your company, how do you know when it is time to try? When considering outsourcing design, it is important that the company and team culture are ready to accept significant input from outsiders. It’s also a good idea to get the contractors involved right from the start. Before bringing in industrial designers as staff members, ensure that the person responsible for recruiting has experience working with industrial design people.  In the absence of such a person to help, it may be better to work with consultants first to get a feel for what you really need. In any event, just as the last decade has brought increased competition and globalization trends to the healthcare industry, the next decade will bring an intensification of these trends along with new challenges. Industrial design is a powerful tool that can help OEMs meet and exceed customers’ 
expectations.


References
1. B Evans and J Wyler, “Beyond Brainstorming,” Medical Device & Diagnostic Industry 26, no. 9 (2004): 46–53.
2. Clayton M Christensen, The Innovator’s Dilemma: When New Technologies Cause Great Firms to Fall (Boston: Harvard Business School Press, 1997).