Today's implanted medical devices hold the potential to support wellbeing and proactively address preventable diseases in a more meaningful way than wearables ever could. But there are some glaring problems--including the "creepy factor" of implanting electronics into one's body--that must be overcome.

Stuart Karten

We are coming to a crossroads in the human-machine interface. 

Advances in battery technology, microsensors, and mobile technology networks have brought about a new category of medical products: invisibles.

In the last decade, companies like FitBit, Catapult, Nike, Apple, and others have created wearable products that monitor various physiological measures to increase performance and wellness by tracking mechanical load, steps, sleep, heart rate, and other measures. While the global wearables market is slated to continue growing in the coming years, this product category suffers from a fundamental flaw: users are abandoning their wearables after just a few months of use.

"Invisibles," on the other hand--also referred to as implanted devices, insertables, electroceuticals, and digi-ceuticals--overcome this hurdle by migrating directly inside the body, where they can't be stuck in a drawer and forgotten about. Rather, they provide life-saving treatment and/or automatically, continuously, and seamlessly collect precise data, all while causing little to no disturbance in a user's daily life. For example, Medtronic has the Reveal Linq, an insertable cardiac monitoring system to diagnose and treat irregular heartbeats. Endotronix makes an implanted sensor that measures pulmonary artery pressure--an accurate indicator of cardiac function--and transmits the data to the patient's care team. And numerous implanted neuromodulation products, which electrically stimulate specific nerves, have started to emerge, with applications ranging from depression, Parkinson's, tinnitus, and Alzheimer's to epilepsy, ischemia, obesity, and sleep apnea.

Implantables hold the potential to support wellbeing and proactively address preventable diseases in a more meaningful way than wearables ever could. But there are glaring problems with invisibles that must be overcome in order for the industry to take hold. For one, there's the "creepy factor:" embedding electronics into their body simply freaks people out. We frequently hear from patients that having a foreign object living inside their body makes them feel like a robot. Secondly, the user experience around implantables is still largely undefined. Implantables have been engineered precisely for function, but technology makers have given almost no thought to how patients interact with their implanted devices. Patients have no way of accessing the data from their implantables, or even understanding how their implantables work. All of these factors help explain why, despite the potential value they offer, implanted devices are considered a "last resort" line of treatment in most cases.

As innovators continue to develop new implantable products--essentially turning people into body computers--they will need to answer some fundamental human questions: how does the patient experience the implantable in his or her daily life? What touchpoints do they interact with? How much control does the patient have over an implantable? What information, if any, should it provide, and what can a patient learn from it? What information do doctors need from an implantable? How do implantables make people feel about themselves and about their health?

In the last few years, I have been working with numerous clients to humanize the implantable experience. I believe the technology must be designed to make people feel more human, rather than part machine, by creating a positive user experience that provides them with real value. 

One way to do this is to tap into users' values and desires. I recently worked with an implantable cardiac defibrillator (ICD) company to improve patient engagement. ICDs are complex computers with embedded sensors that can track heart rate, respiration, blood pressure, and other vital statistics. But the actual patient experience doesn't leverage this data to involve patients in their health--it leaves patients completely out of the loop. The traditional implantable defibrillator is a mysterious stranger living inside the body.

When we talked to ICD users, we found out that all of them wanted more information on their hearts and their pacemakers. They wanted to be confident that their implantable was functioning as intended, and they wanted to know about any heart episodes they experienced. This desire for knowledge was an entry point--a way to get people engaged. We designed an app that would give patients insights and tools to manage their heart conditions. To develop a "sticky" interface that motivates people to achieve positive behavior change, we started with not just a clinical need, but an emotional need.  

It's also important to ensure that the everyday patient experience does not detract from the benefits a technology provides. It doesn't matter if a device produces valuable information; if it's a burden in someone's life, it will be perceived negatively. This is a big challenge for many cutting-edge implantable developers, who often focus their engineering efforts around the implant itself, and how it gets embedded in the patient. The patient's health journey thereafter is largely ignored.

For example, my client Axonics Modulation Technologies has a next-generation neuromodulation system that uses electrical stimulation to treat overactive bladder (OAB) conditions, with clinical trials slated to begin across three continents in 2016. In addition to the shame and embarrassment OAB patients felt about their conditions, they were experiencing major usability challenges around charging and controlling their implants.The implant remotes and chargers were bulky and complicated, with pixelated screens, tangling wires, and unclear icons that made it difficult to make minor adjustments to their therapies. To fix that, we helped Axonics create an ecosystem of touchpoints that make users' relationships with their neuromodulation implant more harmonious, including the first cordless inductive charging device that enables patients to be mobile and go about their daily lives while charging their implants. We updated the look and feel of the devices, elevating their aesthetics to emulate the sophisticated mobile devices that people have come to know and love.

For many people, implantables are a frightening idea, just as taking a pill was once a foreign concept. However, design can play a key role in altering people's attitudes toward implantables. Technology must be seen as an ally in the health journey, not an intruder. By considering the patient's journey as a whole and understanding their cognitive, emotional, and physical interaction with implantables, we can build a comforting context around the technology--and make the implantable experience a little less scary.

Stuart Karten is the principal at Karten Design (Los Angeles, CA).