With the release of the Apple Watch this week for public purchase, we are now seeing the implementation of wearables that have the ability to pick up potentially clinically applicable data from the user. Google’s Fit and Apple’s HealthKit are further blurring the lines of performance tracking and relevant health information. All the while, the packaging is slick with clean interfaces and cutting edge hardware integration.

More than ever, design is playing a big role in medicine and health care. In everything from medical device designs, where the end user is the physician, on through publicly accessible technology such as the Apple Watch, design clearly matters. A significant amount of effort (and funding) is going towards ergonomics, form, interactivity and ease of use. Companies such as IDEO have been working in this space for decades with their innovative methodology regarding human-centric design, and even the upcoming Dell School of Medicine in Austin recently announced the collaborative creation of the Design Institute for Health (helmed by IDEO alums Stacey Chang and Beto Lopez) where the focus will be design thinking and creative solutions in the health care field.

This past week while working with other surgeons performing laparoscopic colon resections, I was struck by the sharp contrast of decades-old instrument designs and the recent device additions to the operating room. Coviden’s Ligasure energy device we use now is distinctly ergonomic, intuitive and a well thought out blend of form and function. Down to the UI of the power source LCD screen, and even the audible tones to indicate stage of cauterization, it’s a device that is a great example of how device companies have a major focus on ease of use and aesthetics. In contrast, we are still using stainless steel forceps and needle drivers who have correct methods and techniques of holding and using that are not immediately obvious.

The field of medicine and especially the field of surgery is one of legacy and history. Instruments and procedures are named after pioneering individuals whose names are always spoken in a reverent tone. As such, these instruments shouldn’t be immediately rendered obsolete as they are a critical and fundamental part of the surgeon’s armamentarium, but perhaps there is a way to improve upon them.

Aesthetics, design, UI/UX are factoring heavily into products in every field and medicine is no exception. If anything, it is now a requirement. Cumbersome, overly complex or clunky designs are no longer acceptable in new products entering the market.

When I design my devices for the OR, ease of use and intuitive-ness are high on the list of importance. With more recent studies on the IDEO methodology and through conversations with the wonderful individuals at IDEO, I feel that they have helped me refine this process and approach in an intangible, but fundamental way. Once the intended function of the device is established, build it so that form IS function has become the goal. This is where human-factors engineering comes in to play, as designing with the end-user in mind and thinking about when and where the device will be used is what will ensure its (hopefully) ultimate success in implementation.

With the rapid advancement of technology, and an ever-growing list of companies producing wearable devices, discussions involving not only the concept of Quantified Self, but what direction the world is going with the adoption of these products are becoming commonplace.

Even so, the abandonment rate in regards to the usage of wearable tech is surprisingly high. Endeavour Partners recently published their findings (http://endeavourpartners.net/assets/Wearables-and-the-Science-of-Human-Behavior-Change-EP4.pdf) on this subject. Although 1 in 10 individuals older than 18 own some type of activity tracking device, they found that 1/3 of owners stopped using the device within 6 months and less than half of all owners of these devices still use it at all.

We can all relate to this. Either on a personal experience level or a friend that bought a FitBit and initially would wear it nonstop, but then all of a sudden did not. As an early adopter of Glass and firsthand experience with multiple wearable devices, I found myself no longer wearing Glass on a regular basis after about 5 months of daily use.

So why, with so many companies offering new devices, touting new technology, are we spending our money on the products but not using them?

This is a complex question that has a multifactorial answer.

There are three major factors that play a role  in why users haven’t fully adopted wearable tech:

1. Friction
2. Societal Reception
3. Delivered Value

Friction

This is the most fascinating aspect of wearable technology abandonment to me because the bar is set extremely low. Friction is defined as difficulty in use/interaction with the device not only on the mechanical level (buttons, plugs etc.), but also on the way the device integrates into daily activities and life in general.

All companies are acutely aware of this and spend incredible amounts of manpower and funds on making the most user friendly UI/UX possible along with creating the most aesthetically pleasing (though this is always in the eye of the beholder) form that they can. Even so, even motivated individuals that are willing to sit down and learn how to use a device can become frustrated with it very quickly leading either to improper usage (and further frustrations resulting in abandonment) or immediate abandonment due to unsuccessful use.

Although we all believe that the addition of a device in our lives will be easy and that doing something as nominal as plugging an activity tracker into the computer every evening is not a lot to ask for, our actions (or inaction in this case) speak volumes. We are just not self-motivated enough to add another piece of technology into our lives for personal use in the long-term setting.

Societal Reception

New devices and technology always takes some time for society to accept it. We live in an age where a conference, show, or convention showcasing new electronic devices happens almost every month. Technology is reaching us faster than we as a whole can process it, and allow for its natural integration into our lives.

With more disruptive devices such as Glass, it is quite literally in your face not only for the wearer, but also for those that the wearer interacts with. As much as we want to accept and integrate it, public acceptance of Glass in the everyday setting has just not caught on. Although I never had a negative experience while wearing Glass, I was acutely aware that others might view it with suspicion or curiosity. I found myself taking it off, turning it around, or at least pushing it up on my head regularly as I moved from one social setting to another.

FitBit, the Nike Fuelband and other activity trackers are certainly more accepted due to their small size and more traditional location-of-wear. At the same time, others easily notice them due to bright colors, distinct shape and design. There is an undeniable “techni-ness” to them that does not blend naturally with clothing, wristwatches and makes them almost immediately noticeable even when they are neutral colors.

Delivered Value

This is what a device “gives” you. Activity trackers tell you the number of steps taken, approximate calories burned, and so on. Glass lets you interface and access your e-mail, messaging, (limited) web, listen to music, take photos and video along with the ability to share them and more.

On the surface, these seem to be high value and desired features and information by the end user. Abandonment rates speak otherwise. Without outside incentives (such as institutional rewards programs for wearing FitBit), people cease to focus on what information the devices give them. As the information is not even clinically relevant, beyond some level of personal knowledge, the devices provide little else.

In the case of heads-up displays such as Glass, nearly all functions are already easily available (and socially accepted) in smart phone form. Looking to the upper right corner of your field of view instead of looking down at your phone is not a big enough advantage to ensure long term adoption of a device that needs to be worn on the face, needs to be recharged, and also still needs to be paired to a phone (or linked to wifi) to use most of the features.

So what does this all mean?

Wearable tech is here to stay. The field is relatively new, especially in the public market and as a whole, companies are still trying to feel out and test what will result in long-term adoption. Apple’s upcoming watch is a big step into addressing all three issues with device abandonment. Aesthetically it looks almost exactly like a classic watch, has (what appears to be) an intuitive UI, and has built in sensors and programs that collect potentially clinically relevant health data. As we get closer to the release date, it will be interesting to see how it is received.

Companies such as Google have also recognized that device value and long term adoption rely (at least for now) on making usage specialized, mandatory, or indispensable. With their recent announcement of the end of the Glass Explorer program and a new focus on business use cases, Google has clearly seen that the device has a place as a tool in a business/work setting (as a telepresence troubleshooting device, as a telementoring platform, and as a hands free communication device) in contrast to generalized public use. By focusing in on specific industries and situations-for-use, Google (and more specifically Tony Fadell of Nest) is pivoting their focus with the understanding that they have a great concept and need to put their time, energy and resources into fields of highest yield.

Coming from the medical and surgical field, I still believe that Glass has value in the hospital. Although adoption has been slow (part of the friction of new technology use), there is immediate understanding of the potential value of a heads up display system like Glass with application towards patient care and physician training.

What the future holds for wearables, where they will ultimately settle out in terms of use cases, and how they will enter our daily lives is going to be fascinating to follow. As technology continues to improve and shrink, long term adoption and acceptance may very well increase as the hardware becomes more and more integrated into already-worn or carried accessories such as glasses, watches, wallets and the like.