I saw this tweet by Rasu Shrestha.

I interpret it as a challenge to healthcare stakeholders to consider the importance of user-centered product and experience design in our work.

Using a regular glass ketchup bottle is a poorly designed experience. To serve the ketchup you have to hold it at a 45 degree angle, tap it in a special place, insert a knife, and then it splatters not only onto your plate but also onto your lap.

Lo and behold the improved design of the squeezable plastic upside down ketchup bottle; the ketchup is right at the opening, it has a valve that doesn’t leak, and it comes out of the bottle faster! Heinz designed a better ketchup experience, resulting in a product that is easier to use, which has lead to product design awards and greater sales.

The unfortunate reality is that this kind of product/experience design doesn’t often occur in healthcare. Instead, this is what happens:

No innovation in product or experience design, just higher prices!

The Epi-pen is a prime example of this.

As a food allergy mom, I’ve written about the bad design of the Epi-pen injection delivery system. To give the injection, you must pull off the blue cap, but the needle pops out at the opposite end which is counterintuitive. Users will inadvertently place their fingers over the needle, leading to thousands of unintentional injections of individuals trying to deliver the medication. The Epi-pen is so badly designed that it’s used as a case study of bad medical device design by human factors design professionals.

Unfortunately because of recalls of other allergy medications, there are no other competitor products. As described in an article from STAT, Mylan the company who manufactures the medication has increased the prices dramatically. Whereas it used to cost about $100 for 2 epipens, the price has increased to $600 or even $900.

Pharmaceutical companies usually justify their price hikes based on the fact that they are funding not only the cost of medication but also research and development. However, Mylan bought the rights to the medication in 2007, and hasn’t made any substantive changes to the design of the device. This has lead to comparisons of the company to Martin Shkreli and Valeant Pharmaceuticals, given the lack of competitor products.

The prices are having an impact on patients and families, who can’t afford the medication and are forced to carry around expired pens or take a huge risk and go without the medication. Sadly, emergency medical technicians in Washington State can’t even afford to carry standard Epi-pens, so they have created their own Do It Yourself Epinephrine Injection Kit, that consists of a vial of epinephrine ($4), and needles ($1). (Yes incredibly, you can buy ampules of epinephrine at a fraction of the cost of an epipen, which means that we are paying $600 for a hunk of badly designed plastic!)

The irony is that the DIY solution may be the better designed solution. The cap is at the same end as the needle on a regular syringe, so the inadvertent injection is less likely to happen. In addition, use of the kits has lead to more extensive EMT training regarding management of allergic reactions, who were often reluctant to use the medication if symptoms weren’t severe, and has lead to increases in the appropriate use of injections from 40% to over 98%.

As Kate Farnsworth describes:

Perhaps food allergy patients and caregivers will have to follow the do-it-yourself model of Nightscout, a DIY mobile technology system for diabetes that was created by patients and caregivers. The community provides support to help individuals create their own DIY medical devices in a variety of ways, including providing the open-source code and instructions online, providing virtual support through a Facebook group, and providing in-person support through DIY “build” parties.

Are “build parties” for DIY Epinephrine Kits on the horizon for the allergy community?

The sad state of healthcare product “lack of innovation” and cost is a major #healthcare #design #fail and is happening not only with Epi-pens but also with insulin, Narcan, and a variety of other pharmaceuticals.

We pay lots of money for bad design in healthcare. When will device and drug companies create user-centered innovations that actually improve the lives of patients instead of their bottom line?

I tweet and blog about design, healthcare, and innovation as “Doctor as Designer”. Follow me on Twitter and sign up for my newsletter!

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A version of this post was published in Fast Company Design.

P.S. Special thanks to @CatchTheBaby for the tweet to the STAT article!