Ben Rubin, Zeo and David Rose, Vitality

I finished up the panel by presenting some thoughts on how patients and caregivers feel about managing care at home. They are struggling with the increasing number and complexity of tasks they are being asked to manage. While it is great to imagine a future of careful monitoring and measuring and feedback, this vision must be balanced with the reality that patients and caregivers don’t want to be inundated with data about their health.
 
David Barash, the president of Concord Healthcare Strategies, and the moderator last night, helped frame the discussion from his perspective as a physician, pointing out how overwhelmed many physicians are with the task of monitoring so many patients, but that the new generation of doctors is becoming more comfortable using technology as a tool to support this.

Frank McGillin, Philips and Devorah Klein, Continuum

It was a fun evening, with a large and lively crowd. My only complaint was that we ran short of time, which curtailed discussion. Given that there were some clear points of disagreement that could have ripened into full-blown debate, this is a shame. But it did ensure that no fistfights over, say, the role of cell-phones in home healthcare erupted.

With the recent banning of Speedo’s LZR sharkskin-inspired speedsuits and the exposure of possible steroid use by Boston Red Sox baseball player David Ortiz, it raises an exciting question: What role does design play in the evolution of sport?

Michael Phelps’ eight Olympic gold medals is a record that may never be broken, all set while wearing Speedo’s suit. The suit is modeled after the drag-resistant texture of sharkskin and compresses the swimmer’s body in key areas. Though Olympic records are falling, most world-class swimmers have access to the suits — is this an unfair advantage or an enhanced design?

Andy Roddick hits tennis balls fast. 153 MPH fast. Speeds like these were unheard of in the days of Rod Laver and wooden tennis racquets. Nowadays it is commonplace for men and women on the professional tour to be serving well above 100 MPH. Now that graphite, titanium and ceramic composites are routinely used for weight reduction and enhanced rigidity, even beginners have the opportunity to use something much improved over the tennis racquets of yore. But are the racquets improved or is the game just different?

400-yard drives on the golf course? Not before monster-sized titanium club heads.
Track spikes that are lighter than a slice of 7-grain bread? Not just for Olympians anymore.

Why should full-body swimsuits be any different?

Can a shoe be too light? Can a ski have too much spring?

Should altering an athlete’s equipment be any different than altering an athlete’s body? What is “ethical” body-altering? How about Red Bull energy drink? Can an athlete with a super-reconstructed knee jump higher or cut quicker than one without? How “able” should an athlete be? How soon will it be before athletes intentionally integrate prostheses or have healthy joints and limbs replaced with titanium ones before the original is worn out?

What is “performance enhancing design”? Few groups are asking and acting upon such questions — certainly there are lots of terrific opportunities to evolve sport and enable our bodies to push the limits of sport, but within what ethical boundaries? And how can (or should) design enhance such experiences?

In our latest engagement with Respironics, a leader in the home respiratory care market, we faced an interesting challenge: take an intimidating piece of medical equipment–a Continuous Positive Airway Pressure (CPAP) machine–and make it feel approachable and usable for sleep apnea sufferers. We realized quickly that the use of a CPAP comes with much stigma. Patients are required to wear a cumbersome mask and tube system that simulates breathing during the night. As a result, the treatment helps deliver a regenerating, restful sleep.

We were recently honored with an MDEA Award for our work on Respironic’s REMStar CPAP base station. It got us thinking. With the rapid increase in Point of Care (POC) medical devices, we frequently find ourselves having to translate the aesthetics of in-hospital devices into versions appropriate for consumer use. Below are some guiding principles we use to design solutions that make conditions like sleep apnea or diabetes a smaller part of life:

1. Life Enhancement vs. Life Support

   People do not want to be made to feel sicker that they actually are. Often predicate devices look daunting, scary, and do nothing to make the patient feel better about their condition. One of our main goals when designing a medical equipment is to communicate an appropriate level of seriousness while removing the feel of an intimidating “medical” device.

2. Understanding the Context of Use
   
   As you would expect, doctors instruct patients on how to use their new CPAP machine during normal clinic hours. However, most real-life interactions with the device occur at night when the users are woken from sound sleep. Thus, they often make adjustments in the dark and without using glasses. The interface had to facilitate people making adjustments to the device with their “eyes closed”. Uniquely textured buttons with variable elevations allow users to identify and adjust the correct buttons by touch alone. The primary control knob is large and prominently located so that it is easily found, and detents allow the user to “count off” the level of adjustment by feel.

3. Simplifing the Interface
   
   Many CPAP users are mature and afraid of electronic gadgets. When treatment starts, there are a set of pre-programmed variables that are only adjusted by clinicians. Most patients will never interact with those functions during day-to-day treatment. With the new device clinicians program the custom patient setting and then hide the display and setup interface under a hinged door leaving only the minimal patient adjustment controls visible. This removes any sort of patient anxiety about accidentally changing settings or altering their prescribed treatment

4. Reducing Stigma
   
   One of the main impediments to compliant usage of a CPAP is the patient’s anxiety about revealing their condition to others by prominently displaying a large piece of intimidating medical equipment on their nightstand.To address this issue, the design team developed a device that had appealing, peaceful, and calming design cues. The design language of the machine mimiced high-end home electronics by using softly curved surfaces and a rich but fairly neutral color palette . As a measure of our success, a study published in the June 2005 issue of Chest showed that patients using a REMstar Pro used their therapy an average of 1.7 hours longer per night than patients on CPAP after three months. And the difference in adherence widened over time.

5. Recognizing Regional Aesthetics
   
   One shoe does not always fit all. While designing the RemSTAR, the team was aware that the main markets for it were in Europe and Asia. Thus, the platform needed to have universal appeal. A global aesthetic preference study allowed us to understand the aesthetic drivers for each market. We then blended those to create an aesthetic that would satisfy the greatest number of Respironics’ stakeholders.