The hidden risks with smart injectors - is high-tech sacrificing usability?

By Andy Pidgeon, Head of Usability

The push for ‘smart’ injectable devices aims to improve patient outcomes, but complex technology risks compromising usability, especially for diverse users with varying tech skills. By prioritising user-friendly design and real-world testing, manufacturers can create solutions that enhance care without sacrificing simplicity

As healthcare continues to embrace the digital revolution, the rise of connected, so called ‘smart’ injectable devices has been heralded as a potential breakthrough in patient care.   

These smart devices promise to improve adherence, capture real-time data, and empower patients. They are often seen as the future of drug delivery, especially for home-based treatments. However, the drive toward smart technology may be compromising one critical aspect: usability.  

When it comes to high-tech injectables, it's not enough for devices to be smart. They should not just be designed with the end-user in mind, but with the user at the centre of the development.

This article discusses the hidden costs of smart injectables, exploring how technology advancements may be creating barriers for patients, and what can be done to ensure these devices truly benefit everyone. 

1. User diversity and tech literacy

A key challenge for smart injectable devices is accommodating diverse users with varying technical skills. Many devices assume a basic level of tech knowledge that isn't universal, making them difficult for elderly patients who may struggle with smartphones or digital interfaces.   

Similarly, patients with low health literacy or who are from different socioeconomic backgrounds may lack reliable internet connection or the skills to use complex technology. In usability trials, these issues often surface, but in real life, they risk alienating those who need the medication most.  

For example, an elderly patient with rheumatoid arthritis might benefit from a smart auto-injector's design, but if it's too complicated, they may end up needing assistance, defeating the purpose of independent use. While the technology may be well-designed, its usability is limited by the extra burden it places on certain users. 

2. The paradox of choice

Smart devices offer unique customisation options tailored to patient needs, but too many features can cause decision fatigue and confusion. While advanced options may seem beneficial, they can overwhelm users, making it difficult to customise settings or understand essential functions, leading to frustration, or improper use.   

This paradox is common in many connected devices. In my experience, patients - especially those managing chronic conditions - often express a desire for simplicity. They want to administer their medication reliably, on their own, without being overwhelmed by notifications, settings adjustments, or confusing interface designs.   

I’ve often seen design briefs that include an extensive feature list aimed at healthcare professionals, resulting in overly complicated interfaces. Additionally, the cost of regulatory approval encourages multifunctional platform devices, which may compromise usability for specific cases. Ultimately, more functionality isn't always better; manufacturers should focus on features that genuinely benefit patients. 

3. Usability testing: are we doing it right?

Usability testing is standard for developing smart injectable devices, but often occurs in ideal conditions, such as market research facilities or closely supervised settings.

These environments don't reflect the realities of home use. Drawing on my extensive experience in this field, I can say that the key to real-world usability testing is involving patients in their everyday environments where they may be busy, stressed, or coping with physical or cognitive challenges.   

Even factors like the time of day can affect usability testing outcomes. I once observed a Multiple Sclerosis patient fail miserably to understand a device in an afternoon interview that she had found much easier during the morning session.  

While regulatory bodies like the FDA emphasise human factors testing, more rigorous, real-world studies are needed to ensure patients can use these devices confidently and safely. 

4. The costs of non-adherence

A major hidden cost of poor device usability is patient non-adherence which can undermine the benefits of smart devices in some cases.

When patients struggle to use injectable devices, they are less likely to follow their treatment plans, leading to worsened health outcomes, hospital readmissions, and higher healthcare costs.  

While electromechanical devices can improve adherence for capable users, increasing device complexity may dilute these benefits as they aren’t given to some users.

User-friendly devices must be easy to handle and intuitive to operate for all users, as usability directly impacts patient outcomes and the overall healthcare system. 

 5. The dangers of over-reliance on connectivity

Many connected injectables depend on internet connectivity, apps, or Bluetooth, which can pose risks if these technologies fail. Patients in rural areas or lower-income households may lack consistent access, making devices unreliable or unusable.  

Connectivity also increases vulnerability to cybersecurity issues, which, though rare¹, can deter some patients from adopting the technology.

Rather than abandoning connectivity, the focus should be on designing devices with usability as the priority. A smart injector should work seamlessly without internet access, ensuring users experience no disruptions. 

 6. Psychological barriers and device anxiety

Unfamiliar technology can cause device anxiety for some patients, especially those already managing chronic conditions. The complexity of smart devices can increase stress, leading to improper use or abandonment.  

Patients are more likely to stick with therapies that they feel confident using, and if a device is too intimidating, they may skip doses or opt for simpler, less effective options.

Addressing the psychological aspect of usability is essential for improving adherence and outcomes. A smart device should empower patients to perform tasks they otherwise couldn’t, particularly for those who are less tech-savvy. 

 7. Sustainability concerns with high-tech devices

As healthcare increasingly prioritises sustainability, smart injectables face scrutiny due to their environmental impact, with electronics, consumable parts, and batteries contributing to waste.  

Simpler mechanical injectors have a much lower footprint, and although reusable smart devices can be more sustainable than disposables, there's still a need to optimise them. It's worth questioning whether all power-intensive, PCB-hungry features are necessary.  

With sustainability becoming a global priority, manufacturers should explore ways to reduce waste, such as developing reusable components or eco-friendly alternatives. 

 8. Competing needs: data capture vs patients

An often-overlooked aspect of smart device design is the conflict between patient and caregiver needs, as they may have vastly different levels of experience and familiarity with technology and needs from a device.  

Many connected devices focus on data collection for caregivers and healthcare professionals, adding complexity for patients who may prefer to manage their care independently and raising concerns about data privacy.  

Compliance with data regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the U.S. or the General Data Protection Regulation (GDPR) in Europe, often prioritises data handling and security over usability.  

This tension can lead to overly complicated ecosystems, making them confusing for patients. Balancing simplicity for patients with the data needs of caregivers is essential to ensure user-friendly devices that still provide valuable information. 

 9. Future innovations: striking the balance

The appeal of deep-tech solutions in healthcare is undeniable, but it's important to avoid over-engineering. Adding advanced features, AI algorithms, or excessive data integration can complicate what should be a straightforward user experience, often increasing cost and weight, and limiting availability.  

Not every patient needs or wants a highly sophisticated solution, and the push for innovation can overshadow the core goal: delivering safe, effective, and user-friendly care. To avoid creating barriers, manufacturers should align cutting-edge technology with accessible design, involving patients early in development.  

Future devices should cater to both tech-savvy users and those who prefer simplicity, ensuring usability remains a priority. Ultimately, smart technology should enhance - not hinder - patient care. 

What 42T does - and how we can help

The current trend for smart injectable devices for home use is targeted at improving patient adherence to generate better outcomes. However, in the process of developing these very capable systems there is a risk that the technology push will compromise patient comprehension and data capture will trump usability.  

Challenges such as user diversity and varying levels of tech literacy can hinder effective use, especially for the elderly or those with limited access to the internet.  

By focusing on user-friendly design, real-world testing, and balanced functionality, we can help manufacturers create devices that truly improve patient outcomes without sacrificing simplicity. Let’s build smarter, not just more complex, healthcare solutions together. 

As leading product development consultants, the 42T team is committed to pioneering healthcare advances through our expertise in solving complex technical challenges for medical device manufacturers. 

Reference 

1. In 2019, the FDA recalled Medtronic MiniMed insulin pumps due to cybersecurity vulnerabilities that could allow hackers to alter the device’s settings remotely  

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answers@42T.com | +44 (0)1480 302700 | Andy Pidgeon | LinkedIn