The First U.S. Ultrasound Agent Pump (IDEO)

Redesigning an obsolete ultrasound contrast agent pump to fit modern needs in the U.S.
OVERVIEW
In the United States, stress echocardiography procedures require manual handling of ultrasound contrast agents. Over two decades ago, our client released an automated pump in Europe to be used with their brand of contrast agent, but the pump has since gone obsolete.

Our client came to us with the goal to understand why their pump was not more widely adopted and to learn modern provider needs around the stress echo procedure for a new device to be released in the U.S.

I led the research for a project to redesign an automated ultrasound contrast agent pump to fit today's stress echo workflow in the U.S.
IMPACT
The research outcomes played a pivotal role in determining the MVP device features and device strategy for a medical device company.
TYPE
Evaluative Research & Industrial Design
ROLE
Design Researcher
Team: Industrial Designer
Client reps: Systems Engineer/Tech Lead, Strategy & Business Director
METHODS
Expert interviews, focus groups, ethnographic field studies, user journey mapping
TIMEFRAME
9 weeks

Background

Context: Stress echocardiography procedures require contrast agents to be injected into the blood flow so that sonographers can capture heart wall ultrasound images. These contrast agents consist of microbubbles that need to be agitated throughout the procedure to prevent them from dissolving. Currently, clinicians manually agitate and inject the contrast agent whenever they need to capture an image. Each test may need 3-6 images.

There are two types of stress echo tests being done: dobutamine (chemically-induced stress) and exercise (treadmill). We learned early on during our field research that dobutamine stress echos would benefit the most from Pump 2.0, and adjusted our shadowing priorities accordingly.

Problem: Our client released an ultrasound agent pump in Europe two decades ago. Since then, adoption of the pump has waned and the product became obsolete. Without a pump, the procedure is completed manually. Our client believed there was a significant business opportunity in redesigning a new pump to be released onto the market.  

Initial Project Objectives:
1) To understand the current stress echocardiography workflow and uncover provider needs.
2) To identify and prioritize new opportunity areas and added value for new design concepts.
My Achievements:

1. Built comprehensive journey maps to detail provider roles and illustrate design opportunities. To help our clients better understand how current procedures can be impacted by Pump 2.0, I drafted a journey map that spans multiple procedures across various hospitals and how they can be optimized with Pump 2.0. I identified the affected variables and the pain points that can be relieved with recommended design features.

2. Crafted the storytelling narrative for the final deliverable. Our client entered this project with certain assumptions around the stress echo procedure that did not align with our research findings. What they had believed was a standardized procedure had actually been adapted to each hospital's training guidelines and to each provider's personal preferences. I crafted the narrative framework and visual design for the final deliverable.

3. Distilled actionable insights that led the client through a strategic reevaluation. Our research findings revealed that our client's initial pump design strategy would not be effective for all stress echo tests. I crafted actionable insights from the research that translated directly into design implications for the MVP and served as a guide through a strategic reevaluation. This was shared in the final deliverable at the end of the project and readily received by client executives and stakeholders.

4. Built a backup research plan in response to project delays and timeline changes. This project's research connections relied heavily on our client's relationships with their customer base and hospitals. When we were notified that field research was delayed, I quickly reached out to IDEO's Health Domain and within one day, created a list of potential hospitals and cardiologists within the Bay Area that we had connections for shadowing. Luckily, we did not need to follow through with the backup plan.

Challenge

How might we address unmet user needs in the stress echocardiography workflow through a new IV delivery device design (to protect client confidentiality, we will call this device: Pump 2.0) to be used with microbubble contrast agent?

Client hypothesis/strategic area: Stress echo tests currently require two providers in the room: a sonographer to administer contrast agent and a nurse to capture images. By introducing an automated contrast agent pump, we can reduce the number of nurses needed for a given procedure.

Questions To Frame the Research Approach

1. What main challenges do sonographers/technicians face in the stress echocardiography testing process?
2. What hacks have sonographers/technicians created for either themselves or their patients around the stress echocardiography process? What’s missing from their toolkit?
3. In what ways is the Pump 2.0 workflow more advantageous than manual bolus injection and saline bag infusion? Who are the stakeholders in the testing workflow and how are they affected by Pump 2.0?
4. What benefits does the Pump 2.0 workflow have as compared to other processes/methods? How valuable are these benefits to providers/clinicians?

Research Approach

I devised a research plan to guide the process through one round of concept generation and refinement. Our deliverables for this project were device concepts and recommendations based on our research insights and learnings.

Research Goals

Key Methods

Timeline

This project was HIPAA-compliant. Because of this, we relied on our client's relationships with partner hospitals to determine our research locations and did not have full control over locations and dates. For this project, my main focus was to work with the client to ensure that our locations represented a diverse selection of large and small hospitals.

Due to planning delays, I shifted Field Research back by one week and used the time to conduct remote research that would set us up for success in the field. As a result, we began to synthesize our research findings while we were still in the field and shortened our Synthesis & Needs Definition phase by one week.

Weeks 1-3: Research Preparation, Context-Setting, and Immersion
Week 4: Remote Research
Weeks 5-6: Field Research

Roles of providers:

Sacrificial concept features that we tested:

Some of the questions that framed our observations and interviews:

Research Outcomes

Identifying Patterns

At the end of each research day, I led the team through download sessions to shift our notes into a digital Figjam board. During this time, I guided discussions to identify emerging patterns and lightly iterate on the discussion guide and design concepts. Afterwards, I continued synthesis on my own to distill research insights.

Key Reframing Moments

Initially, our client had high expectations for Pump 2.0, focusing on two key strategic areas. However, our research uncovered a different narrative.

1. We started research hoping to find moments for Pump 2.0 to add value to all types of stress echo tests. However, we found that Pump 2.0 would shine brightest for dobutamine stress echos, when the provider needs multiple images and the patient remains in place.

2. We originally thought Pump 2.0 could decrease the number of providers needed for a single procedure. However, we found that Pump 2.0 can be
a partner to providers, not a replacement for one.

Journey Maps

To best understand the value that Pump 2.0 provides, the journey is defined by individual steps taken at each hospital, such as contrast agent injections, role changes, and saline flushes. Procedure times were more dependent on factors outside the control of a pump, such as waiting for a cardiologist to be present before starting dobutamine.

Because the procedures at the same hospital were generally similar, I only mapped one procedure for each. The last column is the ideal workflow that would happen with Pump 2.0, which significantly decreases the number of steps needed to complete a stress echo test.

Here's a closer look what one part of the workflow looks like on the journey map. The map is color-coded based on phases of the test. Each hospital has a different workflow with a different number of steps involved for the same test. In addition to the journey maps, I also created room layouts to indicate the providers and equipment present at each hospital.

Research Insights

Three key insights emerged from our research, each leading to specific design implications.
01. A good image is the destination, the journey is up for negotiation.

Providers are often balancing image capture with other tasks during a stress echo test. They preferred leaner pump designs that would help them focus on capturing the images they needed.
Providers want a simple and reliable tool to get a good image, and are less concerned with the nitty gritty details along the way. They remain open to making changes and improvements in their process.

02. Providers have their personal off-label methods of using *contrast agent brand*, but all arrive to the same result.

Even though the contrast agent comes with set reconstitution instructions, we still observed a variety of reconstitution methods and beliefs that providers swore by.
Each provider follows their own set of working contrast agent beliefs and techniques adapted to their preferences from formal training, tips from colleagues, and personal experience. 

03. Pump 2.0 should be out of sight and out of mind, for the most part.

For the most part, stress echo tests take place in designated labs. For ICU patients, however, stress echo tests are bedside. Sonographers need to transport their ultrasound machines from the lab to the ICU, and don’t have the extra hand for additional equipment.
Stress echo procedures are akin to a circus act, with providers juggling contrast agents, wires, machines, and more. The last thing they need is a tool that adds to the physical and mental burden.

Research Impact (Wks 8-9)

Product Impact

Our research findings led to a Pump 2.0 MVP feature list, a curated list of essential features for the initial product launch. This comprehensive reference serves as a guiding tool for our client, facilitating a seamless transition through the subsequent development phases post-project.

Here are some of the MVP product implications based on our research insights. The final list was much more comprehensive and specific.
My research insights and design implications created a guideline for our industrial designer to build concepts for Pump 2.0. The final MVP designs for shape, size, and user interface were presented to major client stakeholders in our final deliverable along with the research findings, early concepts, and future recommendations. I also devised the storytelling framework and crafted the graphic designs for the final deliverable.

To protect client confidentiality, I will not be sharing final designs, but here are a few of the early concepts. We also delivered user interface concepts for screens, buttons, and knobs.

The MVP prototype was built out and mailed to the client after the final deliverable.

Strategic Impact

Learnings & Reflections

ProblemResearch ApproachResearch OutcomesImpactReflections