Deborah Adler: MIX09

Deborah Adler, creator and principal designer of the ClearRx Prescription System, talks about the importance of good design to conveying information.
Las Vegas, Nevada
March 19, 2009

(Music, applause.)

BILL BUXTON: And now for something different. So when I talk about design, I actually like to take examples that are outside of the digital world. So, for example, yesterday I talked about mountain bikes. Other places that you got the book that was in your package, it talked about juicers, avalanche beacons, and things like that. And for me, there’s a really good reason for that because by going outside of our world in a way it adjusts for a lot of the prejudices and havoc that have built up just from working in your own narrow domain.

But often to a degree, we can get some objectivity, get some distance, and see patterns that you can take from these outside worlds and bring back into our own practice. And it’s with that in mind that we saw the work of the next speaker. And let’s just be very clear: she is absolutely not from our culture.

For her, a developer is the place where you take your photographic film to get processed. She’s from a different culture. And precisely because of that difference, she brings immense value and interest.

Think about it. In a sense, she’s somebody who’s in her design – this is sort of like a Cinderella story – the design grew out of her master’s project at design school, but it’s design and technology not to die for, but to keep you from dying from. And she revolutionized the packaging and labeling of pharmaceutical drugs.

If you’ve got a grandmother or somebody sick in your family, somebody with dementia and Alzheimer’s, or just somebody whose life depends on pharmaceuticals, you can thank her work, largely, for maybe keeping them alive because as she will say, the risks of accidental taking of pharmaceuticals and medicines is huge, and the costs are huge, and they’re direct to people we know.

And so it’s with really a lot of pleasure I get to introduce Deborah Adler, and I hope as a visitor to our culture, you give her a warm welcome. I think we have a lot to learn. Deborah. (Applause, music.)

DEBORAH ADLER: Thank you. Wow. Good morning and thank you so much. But I do want to let you in on not such a big secret. I was puzzled when I got the invitation to speak to this group of brilliant Web folks because I’m not too savvy when it comes to Web design or development. But then I learned that you call yourselves UX professionals. And UX means user experience. Well, OK, that’s all right, then, because I know a lot about user design.

When you come right down to it and wipe away all the high-tech jargon, you, me, we’re all of us in the business of creating an experience for the customer. And when you can employ design to make that experience a comfortable one or an informative one, well, then you’ve done your job.

For example, when I began my attempt to transform the way prescription drugs are packaged for consumers, I didn’t start by researching the healthcare industry. And I didn’t start by researching the pharmaceutical industry. I started at the bottom, the way any designer would, in this case, it was with my grandmother.

I took a scary episode that she had gone through and tried to change it into a safer, more reassuring experience. Since she was my grandmother, I really understood my customer. And I was able to empathize with her needs. But I was surprised to discover how easily grandma’s needs translated into the needs of all of Target Corporation’s pharmacy customers.

This morning, I’ll be showing you how a personal family situation helped create a different and more comfortable experience for the uncertain and most likely confused prescription drug user.

This is my grandma, Helen. Several years ago, she mistook my grandfather’s medication for her own. His name was Herman, they were both prescribed the same drugs, just a different dosage strength.

When I looked inside their medicine cabinet, I wasn’t at all surprised that the error occurred. This was their medicine cabinet. It wasn’t caused by poor eyesight or carelessness. The only difference was the dosage strength and their packaging. Sorry, the packaging was practically identical, but the only difference was the dosage strength and their first names, which begin with the same two letters, H-E, Helen and Herman.

This could have easily happened to someone in their 20s or 30s and it could have led to a much more dire outcome had my grandparents been taking other types of medications.

So as a granddaughter, I was alarmed for the health and safety of my grandparents, but as a designer, I saw an urgent problem that was just begging to be solved. So I started research on the topic and I quickly realized that my grandparents were not alone in their befuddlement.

I should back up and say that I started research on the topic because at the time of the incident, I was getting my master’s in design at the School of Visual Arts in Manhattan, and I had to come up with an idea for my thesis. And it had to be an idea that I could effectively and eventually bring to market.

So when I started researching it, I realized that they weren’t alone. For example, this is Sarah. Sarah’s prescribed Cardizem CD for her high blood pressure. Because Sarah’s capsule was too large to swallow whole, she chewed her medication, she became progressively weaker and she died three weeks later. Unfortunately, she missed the words – this is her medication – and she missed the words on the bottle warning her that the tablet must not be chewed and it has to be swallowed whole.

This is Henry. Henry suffered from rheumatoid arthritis and was prescribed a low dose of oromethotrexate, and oromethotrexate is a drug for cancer patients, but in low dosages, it’s known to cure things like rheumatoid arthritis or psoriasis. Nevertheless, this killed him too after he misread the label on the bottle and took one pill every morning instead of every Monday. This was his medication. Could you have made the same mistake?

Because I was shocked to learn that 60 percent of Americans don’t take their medication correctly. The number of prescriptions filled in the U.S. each year equals more than 10 per person. If you multiply that by the U.S. population, roughly 300 million, you’re left with a staggering 3 billion prescriptions a year, that’s a lot of room for medication mishaps.

At the time that I was doing my research, we were spending $76 billion a year to purchase medications in the U.S. and another 76 billion to treat the complications that happen when people don’t understand how to take their medication. I know that number may seem small compared to the bail-out plan, but let’s keep things in perspective: That’s a lot.

So as I collected and studied the standard pharmaceutical bottles, it became more and more clear to me as to why these horrible accidents were happening. Information on the bottles are terribly inconsistent and difficult to read. And not just because of poor placement or poor print quality, but consumers often have to turn the bottle in a full circle to read all the information. And that’s a problem because you can’t get everything at one glance. And a lot of times, that critical information is often covered by a warning label.

Some warnings are printed on wrap-around bottles that don’t quite fit the bottle, and of course that means that important directions are often covered or misaligned. To make matters worse, sometimes we have these orange warnings on top of orange bottles, making them much harder to notice, much less read.

Then we have black text and dark-colored backgrounds, also making the warnings difficult to read. The warnings that you can read that do have a lot of contrast – to take with food or do not take with nitrates – well, that’s an improvement, but what is a nitrate anyway?

And consider the confusing icons that accompany the warnings. Take the medication on an empty stomach on the top right, that to me looks much like a gas tank.

The longer, more detailed instructions that get stapled to the bag and usually end up in the trash can when the patient gets home are not much help either. And on the rare occasion that it doesn’t get thrown into the trash, this is what you’re left with, tedious lines of text that are very difficult to read and discouraging on the eye.

As designers, I know that people’s eyes get tired after reading about nine to 10 words per line. They get tired, they want to go to the next line, that’s how we’ve designed books. For an even faster read, we have the newspapers set in columns. I’m not sure of what the average line length on a Web site is, I’d be curious to know, but this is twice the average line length on a book, maybe 22 words per line. There’s issues, kerning issues, no wonder why no one wants to read that stuff.

So as I said earlier, we have a very big problem that was begging to be solved, but not by pharmacists or physicians, to me, this was really a designer’s problem. So I set out to make that my thesis, and this is what I did.

The first issue that I attacked was the label itself. The most clear and prominent information on this label is the drug store logo and the patient instructions, take one tablet daily. Looks like it’s part of the patient’s home address. And take that number 10 in the left-hand corner. Is that 10 pills, 10 times a day? Who knows.

There’s also no hierarchy of information, which is a really big problem, because it makes something like the name of the drug which is quite an important part end up at the bottom of the label tucked in between some other information. It could easily be confused for a manufacturer’s name or a generic drug name. In other words, information on the label is very disorganized and difficult to read. Some information means nothing at all to the patient, it’s even cryptic.

So that’s when I set out to redesign the label. My goal was to give the consumer more confidence and security when taking their medications. And I did this by understanding information architecture and combining it with my own intuition as well as pre-existing cognitive schemas. And that is to say that if were to give all of you in the room five points on how to take your drugs: what the name of the drug is, how to take it, the quantity, the doctor’s name, et cetera. Probably about 60 percent of you would put the first three in the same order, it’s just a cognitive schema that you’re already used to and that is pretty intuitive.

So I tapped into that and I pulled up what I thought the most information was and called it primary information. And nothing else is ever allowed to infringe on that area, and that’s everything above that black horizontal line. Primary information includes the name of the patient, the medicine name, the dosage strength, the purpose, the main instructions.

Then that below that segmented black line, I call secondary information. It’s still important, but not as critical as the primary. This includes the expiration date, refills, quantity, doctor’s information, name, telephone number, et cetera.

And then I moved the pharmacy logo out of the way and off to the side. I originally wanted to make this a standardized label so it was a universal prescription label and it didn’t matter which pharmacy you would go to, you would always have the same prescription label. And I was hopeful that by understanding these adult schemas it would also hopefully increase a patient’s memory, which is to say that you’ll anticipate where the name of the drug is, for example, every time you go to take your medicine.

If I gave you the old prescription bottle and I had you shut your eyes, you probably wouldn’t be able to even show me where the name of the drug is, and in this case, I was hopeful that you could.

I applied colors to my labels, and I did that to personalize medication for each member of the household, sort of like toothbrushes. That way, no two people in the same house would ever have the same color. And I think this alone would have stopped my grandmother from taking my grandfather’s medication.

For my thesis, I changed the shape of the bottle, and the reason was simplicity itself, it gave the bottle a front and a back so you no longer have to turn the bottle in a full circle. The front has all the instructions and the back has all the warnings.

I’m not an industrial designer, so I had to make my prototypes out of plexi tubing and dollhouse materials. I used whatever tools I could to get my ideas across. You’ll notice that there are grooves in the back that I included so that an information card can slip in and out of, so that sheet of paper that used to end up in the trash, I redesigned so that it’s a tri-fold in columns and fits behind the bottle so that the patient has it with them at all times.

I wanted to design these bottles so that people would know at a glance who it belongs to, what the name of the drug is, and how to take it. The label also has space for pharmacists to clearly indicate key information such as time of week or time of day or what it’s for or how to take your medicine.

I included a magnifying lens in the back groove so that people who had difficulty seeing small type could use it to help them.

I love this story because I went into a building in New York one day, the Conde Nast building, and I received this badge to go up to meet with the creative director when I was doing my thesis. And I went up, I met with the director, I came back. The next morning I had these red marks on my badge. And I realized it was a time-released security badge so that if I went back, I wouldn’t be allowed back in the building.

So I chased this technology all across the country to figure out who makes this stuff because I thought wouldn’t it be great if we could apply it to our medicine labels so that when it expires, a big red X appears and you know not to take your medicine.

Well, it turns out that the company that makes – the family that owns this particular labeling system, they belong to the same synagogue that my grandmother who had the medication error belonged to, one of those weird, cosmic coincidences. Anyway, hopefully this is something we can see in the future. A lot more R&D has to go on for it to last for a year, but we’ll see what happens.

So these are the final prototypes that I presented to my master’s design thesis panel. And after graduating, they came in quite helpful. I brought my prototypes to the FDA, the Food and Drug Administration, with the very high hopes of making them a federal standard. That was quite ambitious. And while the FDA was supportive of the idea, unfortunately, their hands were tied for a couple reasons, but the biggest reason was that each state has their own board of pharmacy, so it’s not really governed at the federal level.

But nevertheless, their support gave me confidence and I quickly realized that the fastest way into the bloodstream, no pun intended, was through a national pharmacy. And that’s when I contacted Target.

I knew that Target would be an excellent platform for my product. They’re committed to their customer and they always go the distance to create that customer loyalty. But they’re also committed to excellent design, it’s the core essence of their brand, as seen in this commercial.

(Target video segment.)

I just had a feeling that they would be willing to take a risk with this sort of innovation. And as you can see, I was right. Target took the idea and me under its wings. Working together, we refined my ideas and we developed the Clear RX system. It was an endless collaborative effort including Target technology teams, pharmacy team, operations, training, marketing, you name it. I worked closely with an industrial designer, finally, to create synergy between the bottle and label.

I think there’s an important lesson there because I could have had to keep my thesis and keep the truth to it as much as I could, but ultimately, I really wanted to keep my eye on the bigger prize, which was getting these ideas out into the public. And in order to do that, you really have to collaborate and work with all sorts of different people to make that happen. So they were great partners and it was a humongous collaborative effort, as you’ll see.

One by one, we developed the label, card, and bottle designs that achieved my initial goals, but also met the real-world needs of doctors and pharmacists.

The first thing you might notice about Clear RX is that it’s built for human interaction. It’s designed to fit the hands, eyes, and minds of those taking prescription drugs. The bottle is easy to hold, and its flat surface serves as a platform for all of the relevant information on the label. So no longer do you have to turn that bottle in a full circle to get the information.

My idea for color-coded labels was translated to color-coded rings. They’re available in six colors, and they attach to the neck of the Clear RX bottle. Each family member is assigned a color, and that pharmacy ensures that this color is consistently used for that person, and that provides yet another line of defense for someone taking medication that might be meant for someone else.

You’ll notice that the label is very close to my original. The information is presented in a clear and intuitive hierarchy. The name of the drug is listed big and bold at the top of the bottle, making it very easy to determine the contents at a glance. Now you can see it. Before, you had to search for the name of the drug.

This quickly touches on what I had to go through when I was dealing with the state boards of pharmacy. That was a real thorn in my side because each state has their own rules. So New York and Rhode Island, for example, you had to have the patient’s home address, while no other states did. So I didn’t really want to use that real estate if I didn’t have to because it was just cluttering the label. So we had to develop 23 variations of the same label to make a successful national rollout.

We designed the patient information card, and that’s securely tucked in the back of the bottle now, and it summarizes common uses, side effects, what to do if you miss a dose, and this card stays with the bottle at all times, and it’s also provided in addition to a written monograph, which I couldn’t fully get rid of.

And now the magnifying lens also fits right behind that label, right behind the patient information card, sorry.

I want to quickly touch on pharmacy operations and logistics because I had to develop a system that would be easy for the pharmacist to use. The final label is actually 8 1/2 by 14 inches high. And one of the challenges was to design a label that would fit within a printer that Target already has. We didn’t want to have buy new printers, so we had to really work with RX label producers to get things like bottle lines and punches and scores and everything right so that it would make the pharmacist have an easy job.

So this sheet holds all our information. We got two test printing cartridges and all the printers to make it so that we could have double-sided information too.

So the pharmacist simply takes the stickers and puts them on the bottle, and then that smaller card gets detached and folded and stuck behind the label, and then that bottom part is the written monograph which I redesigned and made it easier to follow, and it fits inside of this binder which is now – it has three holes and it can keep track of all your family’s medications.

We also designed a little medication organizer which magnetically sticks to the spine, and then you can stick it on your fridge. I don’t know how successful that was, I don’t think the magnets are strong enough.

I worked with Milton Glaser to update the 25 most important warning and instructional icons. Take, for example, the new icon for avoiding taking medication while pregnant. Or to read all instructions before taking this medication. Or I love this one, that taking medication could cause drowsiness and impair one’s ability to drive.

Also, you’ll notice that these icons are printed in a horizontal format, and this ensures that there’s enough space on the label to include all of the relevant icons. And this wasn’t always that case, as you know, with your old bottles.

One of the most popular innovations in Clear RX is this spill-resistant bottle. So that the medicine – so instead of pouring amoxicillin or any other liquid medicine onto a spoon and oftentimes all over the floor, all you do is simply insert a pre-packaged syringe and you can draw out your precise amount of medication. This has been a big hit with moms, and it’s our hope that it will improve accuracy in administration and duration of therapy.

When Richard Carmona, the former U.S. Surgeon General, reviewed Clear RX, he thanked me for pursuing this redesign on behalf of my grandparents. It was very exciting. He said, “Her commitment could potentially help millions of people across the country be safer and healthier as they take their prescription medications.” He also said, “I’d like to congratulate Target on its leadership in designing a new, more easily understandable prescription bottle. The new design is a simple yet important step in improving the health literacy of all Americans.” And, again, I think that really shows the strong collaboration between a company and a designer.

US Magazine first broke my story about Clear RX citing its useful design and its unique user interface. And that was an important piece for me, and I think for the design community because it really told the story from the designer’s perspective, and from my grandmother’s perspective, and it could have gone a much different way. So it helps show that design can effect change.

We’ve received awards ranging from the Good Housekeeping Institute to the Institute for Safe Medicine Practices. It’s been hailed by Time magazine, BusinessWeek, New York Times Magazine, and NBC Nightly News also did a piece on it which I’d like to share with you.

(NBC News segment.)

I hate that scene with the flowers. It looks staged, but it’s not. (Applause.) Thank you.

As a designer, obviously, this has been an amazing journey for me. I’d like to show this picture of a pharmacist, don’t mind his head being chopped off. His name is Patrick. And when we first had to beta test the system to make sure it worked. And we picked maybe eight pharmacies throughout the country. And this is one of them in Florida. And I was able to go out there and watch the beta testing go on. And this is one of the first prescription bottles that were filled, and I got to witness it. And that’s really when I realized that started as a school project has really become so much bigger than I am.

This is something that Patrick can really take ownership of, and rightfully so because he’s the one on the front lines that is delivering the medication and dispensing it, and he’s a very important part of this big picture.

Clear RX is raising awareness in the medical community, the design community, and in popular culture. People are paying closer attention to what the patient gets now at the end of the day.

Throughout this process I really learned first hand that design has the power to make a difference.

(Video plays.)

So not only did it make a difference in people’s lives to people that are taking the medication, but it also made a pretty big difference in Target’s bottom line. I don’t think people even knew that Target had a pharmacy. I remember seeing footage of someone in a Target pharmacy area getting Tylenol. And someone was asking them, you know, “Did you know Target had a pharmacy?” And there was as huge pharmacy sign over the guy’s head and he said, “No.” He had no idea. So it’s really that awareness I think has helped them in increasing their market share really significantly. I can’t give you any numbers because it’s proprietary and it’s hard to get those things, but trust me that it’s really improved it, and it’s increased their sales dramatically, especially in that first year.

So as proud as I am of Clear RX, we’re still at the beginning of healthcare innovations, and we’ve definitely not even come close to reaching a final destination. I’m committed to continuously improving patient safety, patient care, and the quality of people’s lives. And I never forget that this is a continuing and very collaborative process.

So let me give you, free of charge, the lifelong lessons that I learned from all this. What separates you from your competitors is neither design nor development. Absolutely not. Instead, it’s truly thinking about the person who will be using your design or your development and how that design can meet their needs and solve a very human problem.

It doesn’t go too far to say that a successful design experience begins by, one, having a love affair with your customer and really digging into your customer’s needs, and two, bringing your design skills to bear in solving those needs both humanly and humanely.

But you must never forget that if you can’t accept number one, if you can’t understand your customer, then number two is really irrelevant and it doesn’t matter. And a final word of caution that’s really a motto of encouragement, and I encourage you to take it back to your work place. Once you begin thinking of a customer’s needs, it simply becomes a habit. And that habit will lead you unerringly to better design. And best of all, when you bring someone the desire to transform any problem into a desirable customer experience, you’re no longer just a designer, you’re truly a UX designer, and I salute you. Thank you, and enjoy the rest of MIX. (Applause.)