COVID’S Impact on Medicine, Patients & Medical Devices

Bernhard Kappe

Published on: July 15th, 2022

This is an edited transcript of the first episode of Orthogonal’s “Patient Engagement & Connected Medical Devices” podcast, featuring Bernhard Kappe, Founder and CEO of Orthogonal, Adrian Pittman, User Experience Design and Human Factors expert, currently Director of Product Design at LinkedIn (previously of Google and Orthogonal), Gia Rozells, Senior Director of User Experience Design at Becton Dickinson, and Christi Zuber, Founder and Managing Director of Aspen Labs.

You can listen to the first episode of the podcast below, or stream it wherever you find podcasts.

Links to the series of transcripts:

Bernhard Kappe:

If there’s one thing that we all learned by watching children and adults shift school and work to a virtual remote format over the last two years, it’s that there’s a huge difference between showing up and actually engaging.

Adrian Pittman:

And just because you attend an online class, it doesn’t mean that you are actually engaging in that class and actually learning and growing your mind.

Bernhard Kappe:

In the same way, there’s a huge difference between a patient properly using, i.e., being compliant with or adhering to the use of a medical device at home and a patient actively seeking to squeeze every ounce of clinical value out of that device to improve their own outcomes.

Adrian Pittman:

Increasingly, the healthcare and MedTech industries are evolving to support remote diagnosis, monitoring and treatment of health conditions by patients and their caregivers, but without the benefit of the doctor’s office, hospital or real-time supervision, this can get complicated.

Bernhard Kappe:

So how do we get patients and their caregivers, not just to use devices, but to actively engage with them in the best way possible to improve their own healthcare? And for those with chronic conditions, how do we make this happen as a regular routine that just happens without intervention by the provider or payer?

That’s what we’re going to be discussing in this three part series on patient engagement and connected medical devices, presented by Orthogonal.

I’m Bernhard Kappe, Founder and CEO of Orthogonal. We’re all about improving patient outcomes faster. We mostly work in Software as a Medical Device and connected medical device systems, and we apply modern methods within the regulatory constraints to build, evolve and scale solutions faster.

Adrian Pittman:

And I’m Adrian Pittman, User Experience Design and Human Factors expert, currently Director of Product Design at LinkedIn, previously of Google and Orthogonal. We’d like to thank you for joining us today to listen to the first of a three part series from our recent conversations with two fantastic industry experts, who shared their experience and perspectives with us on patient engagement and connected medical devices.

Bernhard Kappe:

That’s right, for this conversation we brought together two people whose work I deeply admire, Christi Zuber, the Founder and Managing Director of Aspen Labs, and Gia Rozells, Director of User Experience at Becton Dickinson.

Adrian Pittman:

In our first episode, we’re going to talk about how the COVID-19 pandemic has impacted the way that we think about how patients engage with and use health services generally, and connected devices more specifically. We’ll be looking at some of the ways that telemedicine and virtual care have bridged the enormous challenges introduced to the healthcare system by COVID-19, and some of the ways that connected medical devices have and have not helped close some of those gaps. First, I’d like to let our guests introduce themselves to you, and then we’ll jump in.

Christi Zuber:

My name is Christi Zuber. I’m the Founder and Managing Director of Aspen Labs. We do a human-centered design approach to understanding people’s needs across communities and organizations, and working with them through a co-design approach to design different solutions. We anchor ourselves in healthcare. It’s not the sole space that we’re in, but it’s definitely our anchor. Prior to Aspen Labs, I spent about 17 years founding and leading the human-centered design and innovation practice for Kaiser Permanente across the country. We opened up all sorts of innovation centers to understand how to get into the heads and lives of people across many different communities. And that really lit the fire in a lot of the things that my team and I are doing now. We do a lot of things in the space around safety nets and underserved communities and how those things are evolving and changing in the future.

Gia Rozells:

Hi everyone. I’m Gia Rozells. Currently, I’m the Senior Director of User Experience Design at Becton Dickinson, which is a big medical device manufacturer. For the past 25-ish years, my role has been to help companies build user-centered design thinking methods into their R&D processes. If user-centered design is separate from R&D, it just doesn’t get done.

I worked for a long time at Intuit, and I think we had big success there making our design thinking blended into R&D so that no one ever thought about it. It was just part of how we developed products. I’m trying to do the same thing now at Becton Dickinson, which is a much bigger company than Intuit. And initially it was a little daunting. What’s great for me about being at BD is working in the regulated medical devices space and having a patient at the end of everything we do. It really makes a huge difference in how I view my work.

My favorite thing is taking marketing folks and engineers into a hospital to actually watch clinicians doing their work in their chaotic environment with their usual workflow, which is much more complex than people realize. And I see my colleagues have a revelation that they didn’t know the users as well as they thought, and that technology itself isn’t the solution that we need to start with. We need to start with understanding the users.

Bernhard Kappe:

Well said. Whether these are clinicians or patients, ultimately they are dealing with work and life. Things are changing pretty quickly and new demands are being placed on them, whether that’s changes to the EMR, or different workflows or new diseases that they’ve had to deal with. My wife is an anesthesiologist, and when COVID-19 hit, they had to revamp all of the safety protocols and everything around that. The vacation we were supposed to take to go to Italy instead was spent revamping the protocols for patients. Do they have COVID-19? Do they not? When do you do testing? How do you protect yourself when you can’t do testing or the testing is inconclusive? Huge changes, right?

Christi Zuber:

Yeah.

Adrian Pittman:

Obviously, the pandemic has had an outsized impact on things that were stress points beforehand. You could argue that it’s revealed and possibly accelerated things that were happening at a different speed or a different level of intensity beforehand. From your perspectives, where is the most movement in industry attitudes towards digital health since the pandemic started?

Gia Rozells:

We definitely saw a measurable increase in telehealth. That arguably is the simplest part of digital technology to apply to healthcare, because everything is the same except we’re over video instead of in-person. Whereas a lot of other e-technology is going to be a lot more complicated.

Christi Zuber:

Jumping onto that, we had the ability to do a lot of care virtually before. That wasn’t new during the pandemic. But it put people in a place where they had to not just lightly consider adopting it but fully embracing it. It was those attitudes and behaviors of, “If we don’t have a choice, then we’ll give it a try, and be okay with clunky or be okay with imperfect more so than before.” It increased people’s willingness or need to actually try it and jump in and evolve it. Pre-pandemic it was just like anything else: It’s easier to stay in the stream that you’re already in, get care the way that you’re already getting care, provide care the way you’re already providing care. It’s really more behavioral than anything. It’s not that new technology was created, but that human willingness adjusted.

Bernhard Kappe:

It took the necessity – “You have no choice right now” – to do that.

Christi Zuber:

Yeah.

Bernhard Kappe:

There were a number of things that were improved by telehealth and things that were not as good. My brother-in-law is a psychiatrist. They did not do any tele-visits in his practice before, but then they switched totally to those practices for talk therapy. For about half the people, it was about the same; for about a quarter of them, it was much worse. They really needed to be in person. And then for a quarter of them it was better, because those people didn’t show up previously. Now there was additional accessibility and it really expanded who was being served.

Christi Zuber:

That’s part of what’s really exciting about all of this is. When you start digging into it, there’s nothing that provides that kind of accessibility in the way that telemedicine can. We need a better infrastructure backbone to allow that to happen, and that is probably going to be part of our conversation today: What we can do, and what areas and people can we reach who didn’t have access for a number of reasons? Whether it’s financial, whether it’s geography, whether it’s timing, for a whole host of reasons, telehealth makes that possible, which is exciting. There’s a lot we need to talk about to work out how we optimize it, but the future’s bright.

Gia Rozells:

COVID-19 was basically an experiment that we were forced into, and telehealth was something that we could already do but didn’t want to, but then we had to. And I love that we accidentally uncovered this great need that we can solve with telehealth in behavioral health, psychology and psychiatry. Think of the vast number of people who weren’t getting treatment before who found it easier to get treatment remotely than to actually go in-person. That’s a great accidental find.

Adrian Pittman:

What’s interesting about that is this concept of accessibility and having access to care. Certainly it became challenging when you could no longer go into the clinic to visit face-to-face with your care provider. At the same time, we expanded our understanding of who we’re serving – going beyond just the end consumer of these services and products. They’re patients, but they’re also medical practitioners.

Let me give you a scenario. A patient comes in with some health tool they want to use. It could be a wearable, it could be an over-the-counter device, it could be something that they brought with them from their previous health engagement with a prior care provider, but the bottom line is the physician doesn’t want to use it. They don’t trust the output and they don’t really think it integrates well with their clinical setup. Or the doctor recommends a completely different device and the patient hates that device because it doesn’t fit with their lifestyle. Have you observed that dynamic? And if so, what would you characterize as the biggest hurdles to driving that alignment between each group exercising their agency to the benefit of the care procedure?

Christi Zuber:

I would say that there are a lot of prongs to devices. When Kaiser Permanente first started using remote devices, we were pretty ahead of the adoption curve because we had the scale to be able to do it. We found that clinicians were accepting of devices. Physicians or nurse practitioners would recommend, “Utilize ABC device. Go home, we’ll send you the things. And we’ll start monitoring that.” Then they’re waiting for the information from the device to come in, and it’s not happening. We thought we had an uptake issue with patients, that they really didn’t want it. We wanted to address it by asking, “How are we introducing it to them? What are we saying to them? What are their reactions when they’re in the clinic setting when you are talking about this?”

Then we decided to apply ethnographic research. We went into the field with some of our IT professionals to see what the hitch was. We observed one of our patients getting the box of gear and opening it up. There was a card in there that had a step-by-step instruction list. The first item said, “Open up a browser.” And they said, “What’s a browser?” And that was it. They put the card back in the box and pushed the box away.

Sometimes it’s those unexpected things. You’re trying to unpack some really complex dynamics when it’s as simple as a term that people get tripped up on. I think we have a lot to learn by actually observing people in context, how those conversations are happening, what steps are people really taking and where are things falling apart. Because it sometimes happens in really unexpected places.

Gia Rozells:

I love that you solved that problem with ethnographic research, Christi.

Bernhard Kappe:

For those of us who are in software and hardware, very often we’re just focused purely on how the patient uses the device or the software and not the entire context. What’s their journey like? What actually happens outside of the use of your software and your product? Because that has a huge impact. Who suggested that they use this device? Who suggested they use something else? If they need a good WiFi signal at home, do they have it? Or are they going to be using it in a totally different context that you haven’t even thought of?

Gia Rozells:

Yeah.

Christi Zuber:

It’s so true. A lot of times we put all this time and energy into solving what we think the real problem is, but we miss the real problem from the get-go. That’s what’s really interesting with a lot of this. It might be different for different populations or different kinds of equipment. But for any of us that are in a space that deals with technology, we have to remind ourselves over and over again that technology is only a small component of it.

Adrian Pittman:

Bernhard and I were involved in auditing a number of clinical processes over the course of our time together, and what we found was very much a patchwork quilt: a lot of different pieces of tech that were never designed with each other in context. Many of them were designed in silos. They optimized for the happy path. Your browser anecdote is a good example. It’s such a basic thing that I’m sure a tech person somewhere in the back halls of whatever company designed that solution was like, “Everybody knows what a browser is. They’ve been around for 30 or 40 years. What’s the big deal?” But a browser, let alone internet access, is still an issue in rural areas even in the 21st century. It makes me think, how much of this is due to design flaws, or the nature of there being no standards across a group of technology purveyors, versus a clinical issue or an issue with the care provider?

Christi Zuber:

At the end of the day, whether it’s individual companies or whether it’s broadband access, there are no real aligned incentives to make any of it really work together. Our industry is very siloed. We think: First to market, gain your shares, push your thing forward for short term benefits then take whatever has happened, flip it and move along. You see that a lot, whether it’s the, “I think the patient dealing is with that” and trying to cobble things together, or the healthcare providers are the ones trying to cobble things together. Things have been bought and put into place that seemed really great at the moment but don’t work long-term.

There’s a lot that we could learn and change to align some of those incentives so that data is flowing the way that it needs to flow across different devices, in a secure, safe, private way and with end products that really work for people. I don’t know how exactly to get to that utopia, but I know that as long as our incentives are very individualistic, by person or by company, it’s going to be hard to get there.

Gia Rozells:

Exactly. Some countries are actually looking to come up with a countrywide strategy to solve this problem. It works in some countries where healthcare is national. I think those countries may jump ahead of us at some point, just because they’re thinking of it in an aggregated manner. They’re thinking of all the different types of users that they have, all the physicians and all the technology that hospitals are already struggling with. They’re starting at a different place than most companies, which are just focused on this one thing that they’re creating. Rather, they’re starting at, “What do we need overall to make this really work societally?”

Christi Zuber:

Yeah.

Bernhard Kappe:

There are a couple of areas where I think it’s going to be easier over time. We touched on it earlier around telemedicine. In the hospital, where we have large capital equipment, really complex internal processes, a lot of turf and a whole bunch of things that people have been trying to integrate forever, it’s a slow slog. But if you look at things outside of the hospital, like at remote monitoring and therapies that are applied at home by the patients, or that are passively applied, all those things are integrating really well with telemedicine.

To the extent that telemedicine has gotten a big jolt and that does not fade away, right now there’s a big push towards real market share as opposed to building a better mousetrap for managing all of these chronic conditions. But as a device manufacturer, whether that’s for point of care, COVID-19 diagnostics or for continuous glucose monitoring, if those telemedicine providers get real and meaningful market share, it will establish another channel. Integrating well with those things could benefit anyone who is doing home care therapies that are not within the walls of the hospital.

Christi Zuber:

It’s interesting thinking about national health systems. Look at a group like the Veterans Affairs. They’re an awesome entity that functions in that way, where your healthcare is all under one umbrella and your incentives are aligned the same way. That system is doing amazing things for the veterans across our country. That’s where some of those bright spots are. How do we learn from each other? How do we share some of those things? How do we take those that might have extreme situations that do align to try to bring people through a new place? What can we learn from them? I don’t know that many people in the private sector take advantage of or look at places like that.

Adrian Pittman:

There’s a question too of, going back to Bernhard’s analogy of telehealth and Bring Your Own Device environments, where you’ve got your own monitoring device. We’ve heard this from physicians and doctors in the past. They don’t want that data in their ecosystem. They’re like, “I get it. You got your health watch. Good for you. But I don’t trust the sensors on that thing. I don’t want the liability. I don’t want it anywhere near the EMR. I don’t want it anywhere near any of my clinical practices because I don’t want to be liable for it.”

Some of this is a quality issue. To your utopia comment earlier, you could argue that it’s possible. But are we really boiling the ocean here? At what point are we going to be responsible for providing better technology that is, to put it bluntly, competently designed to work within these environments? When we have something that isn’t designed for play purposes or non-life management purposes, where it becomes a critical path thing. Right now we are trying to take hobbies as tools and implement them into the clinical workflow, and that’s why we’re seeing this pushback.

Gia Rozells:

I think a lot of people look at smart watches and other kinds of health monitors and say, “This already has a big section of people who are using it, so that means that this can be medical data.” But the jump between a Fitbit and a medical device is huge.

Adrian Pittman:

Yeah. It’s a chasm.

Gia Rozells:

Yeah.

Adrian Pittman:

Fitbit’s a good example. As a company, they’re not necessarily incentivized to get into that game. As a counter example, we have Apple. I remember the anecdotes about the Apple Watch: They had always intended it to have medical or near medical capabilities, but they held a lot of that back because they didn’t want to hold up the launch of the device. It’s understandable if you’re a traditional retail-based brand or company. But who are the medical device manufacturers that we have today? What are the standards by which these new devices operate, that are compatible with a clinical pathway and are dependable enough and produce medical quality data, but don’t have a price point that puts them well onto the range of the average consumer? What does that world look like such that we can start integrating more of these devices into the telehealth pathway?

Bernhard Kappe:

I always say that the future in medical devices is here now and it’s just not evenly distributed. The areas where the future is playing out in real time is in the diabetes space.

Gia Rozells:

Yes.

Bernhard Kappe:

There, we already have lots of medical grade products that are integrated with watches, with smartphones, in terms of glucometers and continuous glucose monitors, and applications for managing those things. They generate a lot of feedback for clinicians as well as for patients. Is it perfect? No, but it’s certainly moving at a rapid pace and lots of experimentation and integration between all of these things are happening. It’s happening faster there than in other areas, but those other areas will eventually get to the same place.

Gia Rozells:

I would also have used diabetes care as an example of where it’s working. It’s partly because there are only two types of data really that are in play. We’re monitoring your glucose levels and we’re monitoring your insulin input, and we use very specific and not overly complex technology to do that monitoring and capture that data. It is exactly the data that a physician needs and will use. Some companies who are in that business have already dealt with the middleman of the insurance payer, to find a way to pay both the physician and the user and whoever designed the device.

Adrian Pittman:

Are there other areas like that we see maybe in the future? We always like to talk about near term, midterm, long term. Are there any midterm opportunities that we see that are similar to that?

Gia Rozells:

Some of the examples of that might be happening in heart monitoring and implanted catheters and other devices. We are implanting digital devices in people and collecting data from them. That is another, similar example of where this is working.

Bernhard Kappe:

There are other areas, again, where we now have therapies that are being delivered outside of a hospital setting, like all the work in nerve stimulation. Adrian, you and I have worked on a couple of things in that field, where they’re not implanted but rather externally applied nerve stimulators or worn nerve stimulators for conditions. You can get this great feedback loop on the effects of the therapy and use that for a whole bunch of purposes: changing behavior, incentivizing that therapy being followed through on and actually modulating and changing those therapies.

Then there are other areas that feel like they’re really far behind right now. But it just takes one company deciding to go and to run with it, one large company that could change a whole area. I would look at orthopedics as an area that in many ways is far behind where diabetes is, in terms of monitoring, in terms of the data that’s being collected and frankly, in a lot of the incentives around that. But if you look at what Zimmer Biomet, for example, is doing with mymobility and everything that they’ve put together around that in terms of digital health, that’s potentially game-changing. And if they do that, you better believe that the various J&J groups and Stryker will be saying, “If they’re doing that, we’ve got to do it too.”

Gia Rozells:

Exactly. And each time a company solves the problem, it will build credibility for these devices. Little by little, we will build up the expertise and also the acceptance.

Bernhard Kappe:

We’d like to thank our awesome guests for this podcast. Christi Zuber, the Founder and Managing Director of Aspen Labs and Gia Rozells, Director of User Experience at Becton Dickinson. I’m Bernhard Kappe.

Adrian Pittman:

And I’m Adrian Pittman. Thank you for listening. In the next part of this series, we’re going to dive into the art and science of user centered research and design processes for medical devices. This is a really rich topic since our panelists bring a tremendous breadth and depth of experience to this exciting, but really challenging domain. There’s a lot of ground we’re going to cover looking at not just UX for medical devices, but for healthcare more generally, and also, what we could learn in healthcare from UX and other industries.

Bernhard Kappe:

If you enjoyed this podcast and want to hear more content like it, you can check out Orthogonal’s website at orthogonal.io. Our Insight section is regularly updated with fresh content related to connected medical device systems, Software as a Medical Device and Digital Therapeutics. You can also reach out to me at [email protected].

Adrian Pittman:

Or reach me at [email protected]. We look forward to hearing from you.

This is an edited transcript of the first episode of Orthogonal’s “Patient Engagement & Connected Medical Devices” podcast.

You can listen to the first episode of the podcast at the top of this page, or stream it wherever you find podcasts.

Links to the series of transcripts:

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