Carolien Creemers, Maarten Bressinck

27/09/2016

UX DESIGN FOR BETTERPATIENT CARE

Who we are

Carolien Maarten

Carolien is a functional designer at Nobel

Biocare. With a background in biomedical

engineering she focusses on user

experience and interaction design in the

field of digital dental solutions.

Maarten is a functional designer at Nobel

Biocare with a background in Digital

Design and Media (Devine). Maarten

worked as a UX designer in Cambridge

and London and lectured UX and

Interaction design at the University College

of West-Flanders.

https://www.youtube.com/watch?v=aHjI3f92Q9w

VIDEO

AIR FRANCE FLIGHT 447June 1, 2009

The consequences of bad design

Official investigation concluded

that human error caused the

deadly Air France 447 plane crash.

Later evidence however shows

that the pilots of the Airbus

A330-200, and everyone else on

the plane, were in fact victims of

bad design.

Dominated by computers, Airbus designed its planes with less

tactile response.

HOW BAD UX DESIGN KILLED JENNY

Source: https://medium.com/tragic-design/how-bad-ux-killed-jenny-ef915419879e#.rh323z8eg

How bad design killed Jenny

Jenny (fictional name) was a little

girl that had to get a very strong

chemo therapy. It was crucial that

she would get 3 days of I.V. fluid

after treatment to avoid

dehydration.

Tragically three experienced nurses

missed the information due to bad

design causing the girl to die.

“We can’t stand by while people’s lives, health, rights suffer because of bad design”

Jonathan Shariat

At Nobel Biocare we also design for critical environments where a patient’s wellbeing is at stake.

SOME EXAMPLES

What is implant surgery

During implant surgery a missing tooth is replaced

with an implant (the tooth root) and a crown.

This process exists out of two steps:

1. The implant is drilled into the patients mouth. A

temporary crown can be placed on top of the

implant.

2. After the implant and soft tissue have health the

patient comes back and the final crown is

placed on top of the implant.

NobelClinician

NobelClinicianNobelClinician is designed to digitally plan an implant treatment. The dental

surgeon can digitally plan where he is going to drill the implants into the patient’s mouth.

From this digital treatment a surgical

template can be generated for use during surgery to guide the dental surgeon.

Risks and how our software can help

Implant surgery poses risks to the patient. If for

example the dental surgeon does not notice

that his planned implant penetrates a nerve he

might permanently paralyze the patient. It is also important that the implants don’t

penetrate the sinus cavities since this can

cause infections an discomfort for the patient.

Using the software the surgeon can see a 3D

model of the patients head.

NobelClinician

OsseoCare Pro

The OsseoCare Pro app was designed to

guide the user while performing implant drills

in the patient’s mouth. The app shows which

drills need to be used and the speed (RPM).

While crafting the design, hygiene was

flagged as a risk. Medical equipment needs

to be sterile so touching a screen is not an

option. Therefore pedals were added so that

the app could be used without touching the

device.

OSSEOCARE DEMO

ABOUT NOBEL BIOCARE

About Nobel Biocare

Nobel Biocare is a world leader in the field of

innovative implant-based dental restorations.

Nobel Biocare became part of the Danaher

Corporation, a global science and technology

innovator committed to helping its customers

solve complex challenges and improving

quality of life around the world. The company

has around 71.000 associates.

Mahwah, USA Production

Mechelen, Belgium Software development center digital dentistry

Zurich, Switzerland HQ

Dental companies within Danaher

Within NobelBiocare

We are currently growing and it is our ambition to design and develop software for all these dental companies.

DESIGNING FOR MEDICAL

Of course you cannot just simply put a

medical device on the market. There are

strict regulations and systems in place in

order to regulate this. These regulations are

region based for now we’ll highlight two of

them.

Regulations for designing medical devices

• FDA Standard (Food and Drug Administration) - U.S.Focused on protecting public health, provides a clear process and regulations

• IEC (62366) - EUROPEFocused on device usability

From time to time you read in the

newspaper that a new drug or treatment

received FDA approval status usually

meaning that it will enter the market soon

after.

This waterfall FDA process, has a big

impact on how we design and develop our

products here in Mechelen. We will explain

how we map this process on our workflow

in the next slides.

The FDA process

User Needs

Design Input

Design Process

Design Output

MedicalDevice

Verification

Review

Validation

The IEC 62366 is a “revolutionary” standard

(introduced in 2012) within the classical medical

industry. It focusses directly on interface design

and possible patient risks that comes with poor

design.

The IEC 62366 is a guideline that is very patient

centered and focused on usability. It also pushes

the medical device industry to do thorough

usability testing. Which is also really important to

us.

IEC 62366

Following the exact specifications doesn’t directly mean

that you’ll get approval to launch (e.g. you can follow the

process and still create a potentially dangerous product).

Following the process doesn’t always end in clearance

The FDA system is proactive, once you get clearance

you can put your product onto the market.

The IEC system on the other hand works postrelease,

you can release a product once the documentation has

been provided but if criteria aren’t met a product might

be recalled.

A process is a guide not a solution. There are some specific

challenges when designing medical devices.

Challenge #1: Long time to release to market

Complex desktop applications are not made overnight.

For some products it takes years of development

before they are complete and even when a product is

ready you need FDA clearance before you can launch

a medical device on the US market.

This process takes at least 6 months and the product

has to go through a product validation phase. You

need an agreement from the FDA and even for

updates the same rules apply, once the features or

product scope changes, you’ll need clearance.

Challenge #2: Getting customer feedback

Since we develop desktop applications we cannot just

include Google Analytics or other surveys into our

software. Our clients live across the globe and since

we don’t want to add too much to global warming we

don’t take the plane for a one-hour usability test. On top of that dentists and doctors almost never have

time. Ever tried booking an appointment with your

dentist for next week?

Challenge #3: Designing for experts

Many of our users are top dental surgeons in their

respective fields, they have developed their own

techniques and approaches to perform surgeries.

It is very hard to define the exact functional

requirements for all these different approaches and

visions.

Note: Some of them are also very competitive.

Testing medical devices is always

challenging, we have to be certain that our

software and hardware is safe to use before

doing clinical trials. To do this we have strong connections with

a number of dedicated and experienced

dental surgeons who are able to identify

risks and problems. Often these trials are

filmed and broadcasted (live surgery).

Challenge #4: Testing medical devices

Challenge #5: Identifying ourselves with our users is a challenge

Our design team is multidisciplinary with

people from different backgrounds (ux

designers, (bio)-engineers, etc.) but

because our target user group is very

niche yet diverse it is hard to identify the

exact user need and set yourself in the

position of a highly qualified dental

surgeon.

HOW WE TACKLE THESE CHALLENGES

Functional Design

Development

Project Owners

Software Testing

ValidationResearch

Technical Writing

Quality Assurance

We use agile (scrum) methodology!

We can identify a number of clearly defined

phases that a project goes through.

Problem: this process is very development

centered and it works very well from that point

of view but incorporating UX is a challenge.

* Usually we have about 6 2-week sprints per project

PreparationSprint

1Sprint

2Sprint

xStabilization Validation

How we incorporate Scrum and UXTo do this we map a regulated UX process

on top of our agile scrum methodology.

PreparationSprint

1Sprint

2Sprint

xStabilization Validation

+• Field studies • User interviews • Competitive analysis

• Conceptual design • Prototyping • Formative testing

• Detailed interaction design • Brief summative testing

• Detailed summative usability testing

• Report usability findings

Some of our UX deliverables

We can do interviews all day at our offices but

that still does not give us a real idea about how

it feels to actually use our products in a real

environment.

To get the feeling of what it is to drill an implant

into a patient’s mouth or to perform a

maxillofacial surgery using splints we get the

opportunity to attend an actual live surgery to

see our customers and products in action.

We join surgeons in the surgery room

* And even developers can join.

At specialised dental or maxillofacial conferences we have all our fish in one

bowl. It is an ideal opportunity to connect with our users.

At these events we often try to set up interviews with surgeons / clinicians that

would otherwise be hard to tackle.

We go to medical conferences and meet our users

Patient risk mitigation

During our preparation (so before any design /

development work has taken place) we create a

map which contains all features of a project. This

map works as a guide to do an initial patient risk

analysis of the upcoming project.

During the project the development is closely

monitored by the stakeholders to see if no new risks

are being introduced.

At the end of a project we do another validation to

see if the patient risks have been properly mitigated.

We document everything

Yes, we have to provide a lot of documentation, luckily we have a lean

documentation solution. All these documents (e.g. user stories) are stored in

a database so that documentation can be generated automatically.

We create documentation as we are moving forward without actively investing

too much time in writing documents.Test cases

User story

Feature

User Need

We cannot just put a product onto the market and hope for the best. We have to make sure

that our product is safe and works correctly.

When launching a new product, we work with staged launches. Usually we start with a small beta test across a handful of users (that actively

communicate their feedback). Later on the sample size of the beta will be

increased and eventually a full launch will take place.

We do staged launches

ChallengeDesign a solution that makes it easy to

visualize a case workflow in a dental lab

environment.

SolutionWe mapped out the workflow and identified a

number of different steps. With some inspiration from Google’s Material

Design we created a card based timeline that

guides lab technicians through their cases.

Case study 1: NobelDesign cards

Case study 2: Osteotomy cuts

Challenge

Creating a digital tool to do cutting in bone (osteotomies). The tool has to be intuitive, and translate to the way

surgeons work.

Solution

We looked at surgeries and the way bones are cut. We mapped this onto a

digital solution

This all sounds very serious but fun matters!

CONCLUSION

Conclusion

• The biggest challenge is implementing UX in a very regulated environment. This poses a lot of complexities and we keep growing and learning as we move along.

• On a UX level in the medical field we are a bit of a pioneer.

• We try to mix medical seriousness and try to apply the latest design trends, even surgeons like cool products (e.g. they are into the latest wearables and smartphones).

• Our users often invest a lot of money in a nice looking practice, it is important that our

software blends in with these environments.

Takeaway

It might be a weird thing to say but UX designers

are a rare (and almost non-existent) profile within

the medical software field.

With a lot of our competitors, developers are also

responsible for the design. One of our strengths

is that we have a team of dedicated designers

which focus on understanding the end user and

transferring their needs into design solutions.

Questions?

That’s all!

Thank you for joining us today. Have

a drink, and perhaps play around with our software on the demo

machine we have setup.

Additionally we would like to mention

that we are growing and looking for new people to help us shape the

future of digital dentistry. For more info talk to us or visit: http://www.nobelbiocarejobs.be/