Nearly half of all adults in the United States have some type of cardiovascular disease. This group of over 121 million people are often diagnosed with potential arrhythmias but physicians need to be able to diagnose them quickly and efficiently to ultimately save lives. One company is redefining the way cardiac arrhythmias are clinically diagnosed to help physicians do just that. The new device from iRhythm “combines wearable biosensor devices worn for up to 14 days and cloud-based data analytics with powerful proprietary algorithms that distill data from millions of heartbeats into clinically actionable information,” the company says.
The Zio patch provides uninterrupted monitoring of atrial fibrillation (AF) with no wires or maintenance needed. The Zio AT is a small, adhesive, water-resistant heart sensor that sticks onto the patient’s chest for 24-hour monitoring. The device is comfortable and easy to use, helping it achieve maximum patient compliance. It captures data that helps physicians understand the types of symptoms the patient has. In its current form, the device is affixed to the patient by a clinician. The instructions and packaging are all designed with the clinician in mind. After the patient is diagnosed, the physician prescribes the patch, and the patient then makes an appointment to have the device applied. The patient receives their at-home instructions at that time.
“I have had palpitations for many years,” says Diana Miner, a 78-year-old patient who was prescribed the device. “The doctor told me this device was new and not clunky like the Holter monitor I had to wear 25 years ago.” Miner says that no previous tests were able to help identify her specific problem. “Up until this device, none were sophisticated enough to capture my palpitations.”
One of the things she liked best was that the Zio was convenient. “It had a sticky back and went right over my heart. It did all the work except for me pushing a button. It read my heart rate constantly. By pushing the button, it pinpointed the beats that were abnormal. I had a tiny notebook to record every time I felt a palpitation.”
Miner also says it was so comfortable that she didn’t even know it was there. “It was wireless and lightweight. It was very simple to understand. It was not disruptive to my daily routine. The only drawback was that I had to be careful not to get it wet when taking a shower.” At the end of three weeks, she put the device and her notebook in a postage-paid envelope and sent it to iRhythm. The company then sent the results to her doctor.
“It was the best medical device I’ve used in a long time because I finally got answers. Afib was my doctor’s biggest concern, and the device showed that I did not have afib because my palpitations were at the top rather than the bottom of my heart (which would have indicated afib). Now I know that it’s something I can live with. Because of the Zio, I have peace of mind that it’s not something serious. It told my cardiologist enough to know there was no need to worry.”
How They Are Making It Even Better
To improve the remote patient monitoring service, iRhythm partnered with user experience firm UEGroup to completely redefine the user experience of Zio. To empower patients with accessibility and convenience, UEGroup was tasked with converting the process to a 100 percent easy, at-home, remote experience with a mobile app. UEGroup addressed the following challenges:
Creating a complex medical device that patients can easily use without needing in-person doctor visits to monitor their heart rates.
Designing a wearable technology targeted at generally tech-averse elderly population.
Keeping in mind the average tech savvy user.
“iRhythm already has this amazing powerful product. We were tasked with shifting the use from clinic to patient,” says Ashley Nicodemus, designer for the UEGroup. She is a multidisciplinary designer with “a passion for problem solving” in both industrial design as well as digital experience domains. “The new paradigm is that it would be prescribed, and that prescription would go to iRhythm who would mail the device to the patient’s home.”
The project became a way for UEGroup to help iRhythm make the product more accessible and approachable for a patient using it who might be intimidated by this process. Understanding that the patient may already be stressed because of their health, Nicodemus says they wanted using the product to be comforting. So, they worked on figuring out the right tone.
“We were always thinking about how the material was introducing someone to the Zio product and how it can walk them through each point giving them the right information they need at that moment,” she says. This included ensuring that the introduction, the web site, and the box would have the same tone and same experience that the patient saw in the brochure at the doctor’s office. They didn’t want the patient to have moments of doubt that come from disjointed materials that might add stress to an already difficult time.
Making the Materials Work
Nicodemus says younger patients — those in their 40s or 50s — tend to look for video tutorials to gain quick access to information while older patients — those in their 60s or 70s — more often want something physical like a booklet that walks them through the process step by step. She explains that they needed to have both work and work well.
“There is a motion graphic integrated into the app so that if a patient wants to, they can just use the app to walk them through the process, or they can use the booklet, which walks them through the same steps,” she says.
In the final design, the box just tells what the instruments are and what step in the process they relate to. All the instructions are in the booklet or in the app and video. There are items on the box that link to the video, but when using the app, the patient can see it that way as well. Nicodemus says the voice and the way to access the information is consistent across all of the materials.
Using UX around the R&D process rather than just the standard marketing materials makes it more about product design, she says. It helps the teams make the product easy to use and make sure that it’s what their user groups are asking for.
For the project overall, she says iRhythm was looking for an improved out-of-box experience which required assessing all of the Zio materials. The challenge was to transform the paradigm from something that would happen in the doctor’s office to an easy-to-use at-home experience.
“Once they get the box, it can be a little overwhelming because they don’t realize how important each step is in order for the patch to be successful. When they have done all of these things, they need to wear it for the 14 days. They need to know what happens if it falls off or it’s not working as they expected. This is the paradigm we needed to understand for someone going through this process,” she says.
Creating a New Experience
Taking the current box and contents, UEGroup identified some of the opportunities where the experience could be changed to make it accessible for use by the patient. They also interviewed the team at iRhythm to integrate what they thought needed to be improved for the next version. Those steps led to some initial design decisions. The UE team targeted the older user population to make it as easy to use as possible.
“If we can make it easy for the 70 year old, then it should be easy for the 60 year old. This is using the universal design principle that we incorporated into this process,” says Nicodemus. “The [original] language and the visuals — and even the way the visuals were oriented — were targeted at a nurse applying it to a person instead of a person applying it to themselves. The language was too technical, and the illustrations weren’t mirroring what you would do to yourself,” she says.
To recast it for patient use, she says they focused on making it a much more linear experience. In this way, the patient can feel like they’re being walked through the process. UE decided to test three different concepts.
“We really wanted to understand what the boundaries were. We have design goals of what this product should do, but we had to prioritize those to understand what matters to the user. The best way to do that was by showing people extremes that push toward these different facets that we identified,” says Nicodemus.
The first concept was a simplified product that removed anything extra and made it as traditional as possible. All of tools and instructions were in one place. One of the downsides of this concept, says Nicodemus, is that the patient was faced with everything at one time, which could be overwhelming.
For the integrated concept, UEGroup brought in the notion of “progressive disclosure,” which she says is something that is often considered for interfaces, but not very often in product packaging or product design. With this concept, they were bridging the gap between industrial and interface design. The instructions would be printed on the box and as the patient opened it up, they were shown a new item to use and what to do with it.
“One of the things we liked about this is that it eased [the patient] into the process. What we thought might be an issue though is that someone could open the box, take all of the contents out, and then not know what goes with what instruction and would have to take time to figure it out.
The third option was a little bit crazier, says Niceodemus. The team presented different scenarios depicting when people might use the product and how a person deals with all of the different packaging, especially if they don’t have a lot of counter space. The concept included a notepad of tear-off instructions that the patient would dispose of as they used them.
During this phase, the team was also continuing to work on the mobile app, which she says also integrated idea of a progressive disclosure of just-in-time information.
Evaluating the Results
With the first round of testing, Nicodemus says they found something that isn’t really new news: people don’t like to read instructions. Rather, she says, they prefer dumping out the box and figuring out what happens with things. In addition, she says people clung to the familiarity of the instruction booklet. But they also liked having the information right next to the item in the box because “it gave them context of what that item was for. The progressive disclosure was helpful for people.”
“So those were the two most popular concepts. When we asked people what they wanted to do, they wanted to combine the progressive disclosure concept with the printed booklet,” she says. “We found that when we did that, it was obviously going to be too much information. So instead of giving them what information we thought was going to be best, we specifically showed them a concept that we knew was going to be too much so they could tell us where that line was. And we watched them to see where they were looking for what information. We got much richer information that way.”
For that app portion, she says the team shifted to more of a “news feed style” because it was similar to what people were used to looking at in their email or on Facebook. They opted to use very large action buttons to indicate something patients might need to do.
The Biggest Takeaway
Nicodemus says it was crucial to provide a consistent voice from the first interaction with the product to the end of the process when the patient would get a diagnosis.
“That consistent voice walking them through the process was the big ‘ah-ha’ that made this so successful,” she says. “Integrating the progressive disclosure method into the life cycle of a product really made a difference for the people exposed to it.”
She believes that this approach could be applied universally to medical devices, especially when the device is patient-facing and being used in the home.
“Having a clear voice helps the patient feel empowered and helps them feel inspired by this new technology they have in their home. Any way to give that feeling to the user is really important for an at-home medical device.”