Wearables have become highly visible in the HCI field; a great deal of work has gone into understanding how the technology can be productized and used. However, most modern wearables have so far simply been miniaturized versions of existing devices that record or show video, audio, biometric data, or movement, or interface with more capable devices.
In their miniaturized form, they bring up issues of comfort, functionality, fashion, and of making technology increasingly invisible and ubiquitous. But there is nothing really new about wearables. Other emerging technologies such as digital tattoos and e-textiles represent a truer departure in terms of devices and the user experiences that can be offered.
Devices worn outside the body have a major upside: They can be easily removed, upgraded, and controlled. However, they do not truly augment the human body; they just provide augmented access.
Wearables have achieved major hype and digital tattoos will too. However, technology for true human augmentation, in the form of implants, is also on the hype curve. And based on my experience, work in that area will be unlike any other type of UX work that has come before.
Very few people have been exposed directly to functioning implants, but that hasn’t stopped the press from making grand pronouncements about what they have to offer. Headlines such as “Plugging In Your Brand and Body - The Future of Implanted Computers” and “A Chip in the Head: Brain Implants Will Be Connecting People to the Internet by the Year 2020” can be found in the popular press. In addition, the emergence of body hacking is creating interest in the early-adopter hobbiest community.
Some see implants as the next step on the evolutionary path of computer technology: mainframe, PC, laptop, smartphone, tablet, wearable. People who espouse these views may have also been influenced by science fiction movies. However, implants do not fit on this continuum. They belong to a fundamentally different path of technology evolution because they penetrate the human body. Once that penetration happens, it is no longer purely an issue of digital technology; it also involves biology, psychology, and physiology.
The Internet of Us
One of the attractions to the concept of implants as consumer devices is the level of convenience they could provide. Many people now have keyless car entry, but you must still have the keyfob with you. Wouldn’t it be convenient to have a single form of digital identity that you couldn’t lose and that handled your identity across many devices? For example, being able to use an ATM without a card or checking out of a store by walking out the door. Or boarding a plane or entering a concert without showing a ticket.
Beyond convenience, there are health opportunities. Biometric sensors with access to the bloodstream could provide information about not only pulse rate but also blood pressure, blood sugar, hydration, kidney function, and the presence of cancer cells—even predicting heart attacks by detecting telltale proteins.
When the portability of implants is combined with shortwave communication, the opportunities for, and the very nature of, communication could change. RFID implants, such as those used in pets, provide some level of communication by identifying themselves via a unique ID signal driven by nearby electrical inductance. What if the information were much richer, always accessible, and delivered with higher bandwidth? A person could be queried for medical records in an emergency, complete with images from past procedures and a detailed medication history. People could exchange information about themselves without using devices. It would be a new age of information sharing, driven implicitly by the human body rather than explicitly by interaction with phones or computers.
The UEGroup has worked on multiple generations of active implants for multiple clients. This work was done over several years and covered several categories of implants used for the treatment of medical conditions. The implants have evolved from experimental technology to the standard of modern care. This work serves as an important reality check for the HCI community about the promise and reality of working with active implant devices.
The types of implants that provide the greatest insight about the future of this technology are neurostimulators. These devices interface directly with the human nervous system and stimulate it in some way. The most well known of these is the cardiac pacemaker. This technology is decades old and has now become a routine treatment for heart conditions. However, a pacemaker does not traditionally have a computing device or communication capabilities, so it isn’t a good analog for the envisioned consumer implants.
A less well-known and less common version of this technology is the cochlear implant, which stimulates the inner ear directly and produces sound for profoundly deaf people. This technology is most often seen on children. However, the cochlear implant doesn’t live entirely in the human body, which makes it a hybrid of wearable and implant. The best examples of true implants are neuromodulators for the brain and spine. The most noteworthy of these is DBS (deep brain stimulation), which stimulates parts of the brain to greatly reduce tremors associated with diseases such as Parkinson’s. This was the technology that UEGroup worked on specifically, including its use for mitigating pain by stimulating the spine.
UEGroup has led the research and design of both brain and spine neuromodulator products. These devices live entirely inside the human body, containing computing power, a battery, memory, and wireless communication capability. They can also be controlled directly by the user. These implants are currently being used to address diseases of the human nervous system in ways that no other technology can, specifically, the sensation of pain and symptoms related to Parkinson’s disease.
When we embarked on this work, we decided to use a true user-centered design process that addressed the entire community of users including surgeons, surgical scrub techs, nurses, neurologists, pain specialists, clinicians, patients, and their families. Here we describe the details of these phases.
Ethnography. The ethnographic research ranged from observing live implantation surgery to programming devices in the doctor’s office to visiting patients’ homes after they lived with the technology for a period of time. The field research presented many challenges, such as having researchers get credentialed as sales reps who could be present during surgery. Beyond the credentialing, there were obstacles in dealing with the surgical sights and smells during procedures that sometimes stretched to five hours and required standing the whole time with no bathroom breaks.
The patient visits revealed both usability issues in the current generation of technology they were using and the acute need for resources for making sense of what they felt and what it meant. The patients tended to be older and sometimes had problems with dexterity, memory, and motor function.
One difficult aspect of the research was patients’ unwillingness to criticize the technology and provide suggestions for improvement because they were so thankful for the improvement it had brought to their lives.
Perhaps one of the most unexpected challenges was the emotional toll of visiting patients and their families. The diseases being addressed by this technology affected the entire family, not just the individual. As HCI professionals, the team was not trained in social work and some of the situations resulted in deeply emotional experiences.
Conceptual design. The findings from the field research were translated directly into design concepts tempered by an understanding of the technology constraints. The overall product solution includes several devices:
- The implant
- The implant charger
- The patient remote control with a GUI
- The implant programmer on a laptop
The design team therefore had to generate both industrial designs for the physical packaging along with matching graphical user interfaces.
User testing. All facets of the solution were tested with users, including the implant programmer, with prescribing doctors, and with patients who had to live with the remote shape and GUI design on a daily basis. In all cases, we used rapid prototypes and simulations to drive a very Agile process of iteration. During testing, it became clear we had to reinvent the meaning of traditional feedback because, in this case, the feedback could actually be felt inside the human body.
Final design. The design was taken to the production level in terms of the industrial design, the GUI, and critical parts of the experience such as a simplified instruction manual.
Although implant technology holds many promises, the reality of putting a device inside the human body has many drawbacks. Here are some of the important issues that users of implant technology must consider.
Entering the body means complications. Inserting an implant means penetrating the human body, which introduces issues of infection, comfort, and unexpected sensations caused by the movement of the implant.
Battery power drives almost everything. Most people have had their smartphone run out of power. Just like a smartphone, implants need to be charged, but because they are inside the body, the process takes a long time to complete when using inductance technology. The closer the implant is to the skin, the faster the charging. However, having it close to the skin creates a visible bulge. In order to retain more charge, the device needs to be relatively large. For any device of this type, supporting the device’s power needs is critical to thinking about all facets of the design.
Can’t be easily upgraded. Most people do not have the first smartphone they bought. They have upgraded multiple times. Unlike a phone, upgrading an implant requires a full surgical procedure. The patients we visited did not have any better options for increasing the quality of their lives, so this meant the possibility of additional future surgeries. If consumers opt for this technology, it will become elective plastic surgery that will have to be repeated over a lifetime. Unlike many mechanical devices, biological beings change dramatically over time. Age will alter the benefit and value because digital and mechanical devices do not presently physically evolve.
The next hacking target. Hacking is becoming a ubiquitous problem for all technology products. Implants will be no different in that regard but present greater dangers to an individual’s health and safety. For medical uses, hacking could result in death. Unlike mobile devices that you can leave behind or shut off, the inaccessible nature of implants means you will not have physical control over them unless the person leaves the situation. Security and privacy will be two huge issues for the implants of the future.
The ethical questions. The media and some pundits are already beating the drums about implants and human augmentation. However, they are thinking about this issue as if it were just another technology. It isn’t. Penetrating the body means surgery, possible complications, and even death.
Implants are not new. Many people know someone who has had a knee or or hip replaced. Some implants are used to hold severely broken bones together. In their day, these were radical devices. Today there are implants that go under the skin to create a fashion statement, including the creation of mock horns on the forehead. There will always be people who want to experiment with the latest and greatest and will do so in ways that some believe are irresponsible. But people are already irresponsible in their use of digital technology. For example, personal data shared on social-networking sites can reveal when people will be away from home, their latest major purchase, their family members’ names, and other information that could be misused. Ultimately the market will decide.
Should technologists and UX professionals shy away from helping this area to grow? For some, this is an exciting technology that will shape the future. For others, it is a scary social nightmare that must be stopped. Like many things in life, it isn’t, and can’t be, black and white. If these technologies do go mainstream, one of the benefits will be that prices come down and medical benefits will be more accessible to more people. Currently, the neuromodulation solutions are about 2,000 times the cost of an average wearable device.
Whatever side of the fence people sit on, it is important to remember that when used properly, this technology is improving the lives of individuals and entire families through its unique ability to address disease symptoms directly from within the human body.
There will be consumer applications, and ideas such as body hacking will grow. They may well fuel a new level of technology fetishization. Questions of what makes us human and notions of self will be debated as more technology is introduced into the body. For technologists and designers, this fact will pose new challenges that will force us all to balance business opportunity, design challenges, and ethics on a new scale. Hopefully we are up to the task. My belief is that we are.
Tony Fernandes is the founder of UEGroup a full-service UX consultancy in Silicon Valley. Previously he led various UX organizations including Netscape’s UX team, the Apple/Claris Human Interface Team, and XEROX PARC’s Inxight spinoff. He has also led designs for some of the world’s leading medical device companies. He is the author of Global Interface Design. firstname.lastname@example.org
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