What is Universal Design, and What Does it Mean for RPM?

September 27, 2023

There is a common refrain within the health system that some population groups are hard to reach. Despite patient advocates being at pains to point out it’s actually the health system that’s hard to reach, not the people.  

Equity of access

Putting people with poor health outcomes in a single group and labelling them “hard to reach” isn’t useful. We must improve access by redesigning models of care to incorporate their needs. If we can get that right, very few people should have difficulty accessing the healthcare they need.

Older people use the health system more than anyone else. At Spritely our entire purpose is to make them healthier, safer and more connected. That’s why we developed a life-changing RPM platform that’s easy to access and simple to use.

Co-design & Universal Design

We achieved this by co-designing the product with older people. Co-designing software is no different from co-designing physical environments like buildings or pedestrian walkways. Users get a voice, and this improves access for the people who use the facilities.

Universal Design is the design and composition of an environment so that it can be accessed, understood and used to the greatest extent possible by all people regardless of their age, size, ability or disability. By applying the principles of Universal Design we made it easy for older people to use the technology, which created benefits we hadn’t anticipated (more on that later).

Here are just a few examples of Spritely design decisions that make RPM easy for our users to access. We’ve grouped them according to the 7 principles of universal design.

  • Principle 1: Equitable Use.
    After speaking at length with a lot of seniors, we made the decision to “pre-provision” our RPM software on a dedicated touchscreen device that we supplied.
    Our research told us that many older patients weren’t confident using their own phone or tablet to manage their health. Our decision to supply a pre-provisioned device, dedicated to their care, created a standardised patient experience that didn’t require patients to have their own device and was easy for clinicians to support.
    We knew it would be challenging to create a system like this that was scalable, but we were undeterred because we knew it would make things much easier for our users.
  • Principle 2: Flexibility in Use.
    By co-designing the Spritely user experience with older health users we learnt that different people want to engage with care providers in different ways. That’s why our solutions includes things like messaging, surveys, and video calling in a single package.
    The flexibility of the platform enables different models of care for different patient cohorts based on requirements from clinicians and their patients.
  • Principle 3: Simple and Intuitive Use.
    Spritely’s software is possibly the only touchscreen software in the world co-designed by people with no experience of touchscreens. We involved seniors with no touchscreen experience in the design process because we wanted to ensure the interface was simple and the navigation was intuitive. Many of our design features can be linked directly back to those seniors who generously gave their time to help us develop the product.
  • Principle 4: Perceptible Information.
    When we were developing the product it became clear that different people preferred to consume information in different ways. We quickly understood the need to offer both verbal and non-verbal means of communication. We also learnt to accommodate non-English speakers and people that had limited vision.
  • Principle 5: Tolerance for Error.
    When we observed our co-designers trying to record their health vitals using a touchscreen they all struggled with Bluetooth connection. Specifically the process of pairing the device through the settings. Everything about this process was unfamiliar and this resulted in a lot of errors.
    The best way to minimise errors like this is to eliminate the root cause. In this case the need to ‘pair’ medical devices to the tablet. Spritely decided to remove this requirement and make all our medical devices permanently and wirelessly connected. We do also allow for manual entry of health vitals, either by the patient themselves or their clinician.
  • Principle 6: Low Physical Effort.
    One of the best things about touch screens is the relative ease with which you manage interactions. Simply tapping the screen enables functionality with relatively low effort compared to pushing a physical button, which is hard for some older people, especially if they have arthritis or dupuytren's contracture.
    We learned from working with older people that you can’t guarantee all fingers will operate a touchscreen equally. Some older people have drier skin (xerosis) and this can limit their ability to operate touchscreens, which can cause frustration. Ohers have a tremor which also makes it harder to tap precisely. Spritely supplies users with rubber tipped pens to alleviate these issues.
  • Principle 7: Size and Space for Approach and Use.
    Spritely touchscreens are a good size for visibility (10.4 inches) and also a good size for portability. Spritely supplies each tablet with a bamboo stand, which can be easily moved to any part of the house. This means consultations can be done sitting at a desk or couch, or taken to a separate room if they need privacy. It can rest next to the bed or in the bathroom depending on how it is being used.

Unexpected breakthroughs

This co-design process led to some unexpected breakthroughs when it came to RPM. We knew that our design decisions would make it easy for older people to access RPM, but we didn’t realise what a huge difference it would make to other patient cohorts.

By simplifying the RPM experience and eliminating barriers to using it we found it to be perfect for other priority populations such as Maori and Pasifika, people in financial hardship and rural populations as well.

Unprecedented engagement

Co-designing this health solution has taken something that was hard to reach for some people, and turned it into something that’s easy for them to access and simple to use. The result has been RPM programs that have seen unprecedented levels of engagement from patients.

Minimal tech-support

Ease of access and simplicity of use has had additional benefits as well. Clinicians don’t have to spend a lot of time giving tech support to their patients. In the past, this has been a major burden on the health workforce, who spent too much time just trying to get RPM systems working for their patients.

Universal design has not only increased usage among priority populations but it has improved the efficiency with which care can be delivered. The outcome is an equity-led telemonitoring platform that makes RPM accessible for large patient cohorts  that previously struggled to engage with attempts to monitor their health remotely.