People often talk about thinking “outside the box” but one of the things most exciting in modern technology is being able to design “off the glass” — meaning a piece of technology that isn't bound to a glass screen with a perimeter of plastic. Thanks to Moore's Law and cheap computing power, designers can embed technology into items worn on the wrist to monitor your health, or shoes that count your steps, or rings that can store data. Or, if you're me, 3D printed armor with microprocessor controlled servos to open your visor. Welcome to the world of wearable computing.

Where Did This Crazy Idea Originate?

The idea of having technology that can be worn as an item of clothing is by no means new. The concept goes all the way back to the 1500s when clocks were cutting-edge technology and the ability to wear one on the wrist was so novel that only the Queen of England was privileged enough to own one.

Fast forward to the 1980s, when Steve Mann, an MIT grad and professor at the University of Toronto widely regarded as the father of wearable computing, began experimenting with backpack-mounted computers. With the perpetual advancement of computing power, coupled with near-ubiquitous access to cloud-based data processing, today we now have rings that can track health and watches that can do video teleconferencing. (Here  are some wearables startups to keep an eye on.)

For designers, this is a very exciting time. Designers are going beyond the flat glass, looking at the physical nature of objects and deciding how to enhance existing affordances with digital intelligence. Mark Weiser, who coined the term ubiquitous computing, was talking about creating the “invisible interface” to computers way back in 1994. Now that's become reality as objects and clothing people are already familiar with become that interface.1

In his book Smart Things: Ubiquitous Computing User Experience Design, Mike Kuniavsky introduced the concept of treating information as a material with properties that we can design with.2 Just as traditional materials like steel and plastic have properties such as strength and elasticity, Kuniavsky proposes that information can be thought of as having properties such as capability, possibility, and constraint that can influence how we design with it.

Designers can think about how physical phenomena can be translated into information with sensors, how information can be stored to maintain state, and how it can be translated back into the physical world by a vast number of actuator devices. For example, consider a pair of smart gloves that can read the ambient air temperature and activate internal heaters when the temperature falls below a value previously set by the wearer.

A New Challenge for Designers

Our challenge as designers comes in thinking about information, or information processing, as a material property of what we are creating — and incorporating it into whatever we are creating in a way that improves the experience Information as a material opens up infinite design possibilities, letting us enable new behaviors in previously inert objects.

In the example above, the purpose of gloves is to keep hands warm and dry, so the addition of information processing makes that more effective. Companies from startups to global players are adding information processing in a spectrum of new products.

For instance, Google and Levi's teamed up to make Jacquard, a smart jacket for bike commuters that incorporates conductive threading — literally a material to incorporate information.3 The left sleeve becomes a touchable surface for interacting with commuter-based services on the wearer's cell phone, letting a rider skip tracks or check time to destination without taking eyes off the road.

Contrast that to the attempts by appliance manufacturers to create a smart refrigerator by basically bolting a screen on the door and adding Wi-Fi. Smart refrigerators (and similar products) haven't gained traction with consumers because the “intelligence” didn't improve the fundamental purpose of the fridge: keep food fresh.

Rather, smart-fridge designers took a “two great tastes that taste great together” approach, and it didn't work. If manufacturers are going to go to the effort of adding information processing to a fridge, it should deliver value. I'd want the fridge to tell me when I'm out of milk or that the lettuce is going bad, and then add the items to the shopping list on my phone.

The wearables market is growing at an exponential rate. (Credit: Andrew Babkin, ICS/Boston UX). Click here to see the high-res infographic.

Some manufacturers understand this need and are coming up with new products to address it. For instance, there's a smart egg tray that can signal when you're low on eggs. Problem is, reviews are mixed. That means there is still a lot of work to be done in this space.

Wearables for Fitness and Health

Also part of the transformational technological wave, collectively referred to as the Internet of Things (IoT), wearable computers are attracting a following. Many of these devices are geared toward health and wellness, helping people better monitor and maintain a healthy lifestyle.

The most common types of medical wearables are, at their core, data collection devices. These clever bundles of sensors and connectivity amass a wide range of biometric data and make it accessible to users by the associated cloud-based services. Heart rate, blood pressure, hours of sleep per night, and even daily caloric intake are among the metrics that can be gathered, analyzed, and visualized. Sensor capabilities and data collection allow individuals to make better choices about their daily lives. For instance, the Fitbit — perhaps the best-known wearable device — tracks exercise and sleeping patterns.

While Fitbit was early to market, these days the shelves are crowded. There are smart watches, rings, necklaces, jackets, and even shoes, to name but a few, that all integrate with cloud-based systems and help us make better decisions about our diet and exercise levels.

These types of health trackers are perhaps the most visible expression of the wearables market to the public. But there's growing innovation in more hospital-grade medtech wearables — devices considered less entertainment and more diagnostic or assistive.

At the 2019 Consumer Electronics Show (CES), one of the novel wearable devices that debuted was the Dfree from Triple W. The Dfree, which stands for “diaper free,” consists of a small sensor that is taped to the user's torso to monitor the wearer's bladder-fullness level. When a preset level is reached, the device sends a notification to the tethered smartphone. Targeted at the elderly and the disabled, this device — life-changing for many users — won the Best of CES award in the Digital Health and Fitness Category.

Short for Gait Enhancing and Motivating System, Samsung's GEMS assists users with walking and can also help them strengthen their muscles and improve their mobility and balance. (Credit: Samsung)

Also making its CES debut this year was Samsung's wearable exoskeleton called the Gait Enhancing Mobility System (GEMS), which provides walking assistance and posture correction. While it's not quite an Iron Man-esque flying, armored exoskeleton, it is arguably more useful to the commercial consumer.

Designing Wearables

Learning how to design wearables will be an exciting challenge for user experience practitioners. Designers need to consider use cases that span both the digital and physical worlds, and figure out how best to meld the two. Information is our new material to build with, as pliable as clay in the hands of talented designers and developers.

Designers already have a pretty good handle on the digital aspects of wearables. If the device has a small screen, many of the same techniques and heuristics that are used to create digital experiences on mobile phones can be applied. However, many wearable devices do not have that screen so their users have to get information from the device in other ways. LEDs, haptics, and even sound can play a part in letting the user know what the device is up to.

Though the interface may differ, a core trait of wearables is that nearly all have some kind of cloud-based service that is an integral part of the user experience. Many devices now come with a companion mobile app that allows users to configure the device and provide much more involved access to the functions of the physical device. Many devices can completely forego any kind of screen by moving complex inputs and output to the companion device. Since the device is pushing data at the smart-phone, it's a short step to getting that data over the Internet and making it accessible over the web.

In fact, it can be argued that the service is significantly more important than the device itself. For example, I have a number of devices that I interact with in my daily life that can play music from my personal collection. That collection lives in the Amazon cloud and has grown over the years, and it's the access to that music that is important to me, rather than the physical device that happens to access it. I can always buy another Echo, but losing my collection of college bootlegs would be devastating!

Designing the physical device is a multidisciplinary endeavor because factors of branding, ergonomics, and industrial design must be considered as well as aesthetics and context. A medical device needs to safely provide information or treatment, yes, but it also must do so in a way appropriate for the user. Understanding the psychology of a device — especially one that directly touches a patient — is essential. In terms of context, designers need to ensure that the design accommodates the environment, whether that's the ER, OR, or any other clinical setting.

FDA Takes Notice

Perhaps the most exciting thing about the medical portion of the IoT market involves changes coming to the industry courtesy of the 21st Century Cures Act of 2016. As part of this legislation, the Food and Drug Administration (FDA) has established processes to help reduce the time to market for new medical devices the agency classifies as Class 1, or low-risk, devices.

To provide guidance and help companies that develop medtech navigate this shifting landscape, FDA released “Changes to Existing Medical Software Policies Resulting from Section 3060 of the 21st Century Cures Act.” This important document explains some of the agency's current thinking in regard to devices and medical-related software systems. FDA's “Digital Health Innovation Action Plan” document further describes this shift in thinking and outlines a plan that allows nine major companies to become precertified to market these low-risk devices with minimal FDA review.4 So look for a whole slew of new wearable medtech in the coming months and years.

As the IoT becomes ingrained in modern life, wearables offer convenient and clever ways to improve people's lives, whether by diagnosing illness, providing treatment, or simply by making the user more aware of health-related metrics. As designers, our job is to make that tech appealing and easy to use. This way, everyone gets to feel like a superhero.

This article was written by Jeff LeBlanc, Director of User Experience for both Boston UX and ICS, Waltham, MA. For more information, visit here .


Medical Design Briefs Magazine

This article first appeared in the May, 2019 issue of Medical Design Briefs Magazine.

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