Medical Electronics Forum

Medical electronics brings with it a variety of challenges for the designer

CONVENED AND MODERATED BY CHRISTINA NICKOLAS

The constant monitoring of patients from the time they step into a hospital, the desire to reduce healthcare spending around the world, an aging population that requires increased levels of supervision and medical intervention, the capacity to deal with baby boomers — these are the most important factors that are driving the medical electronics industry today. Recently, we conducted a forum among industry experts from a variety of manufacturers to discuss issues and challenges the medical electronic industry faces.

Electronic Products : I’d like to focus on miniaturization, which I believe is the most significant trend that is influencing the design of medical devices that would be everywhere from imaging all the way through patient monitoring, through smart drug delivery systems to implantable electronics. What challenges and issues do designers face today and what is your perspective on how these issues can affect the design and part selection process?

Todd Schneider (Vice President, Diagnostics, Therapy and Monitoring Medical Division, ON Semiconductor): Most of these systems typically become “untethered,” right? We’re talking portable devices if you’re making them small in many applications.

A real challenge is low power consumption because you want to have a small battery since in many of these devices, the battery is a significant component of the weight. I see a lot of people facing real challenges just getting very low-powered small-size applications working well. Of course, the other things they always need are typical: they want a good ecosystem: they want tools and support; they want to get to market fast. So we focus a lot on providing what we call total customer solutions.

I think the other thing we see is many manufacturers wanting to deal with fewer vendors. They want someone who can supply a broader portfolio of products to meet their needs. Finally, we see two additional challenges: One is managing user interface in these devices because most of them are very small, so you need some fairly smart technology to manage the interface. The other challenge is that when you make them small and untethered, they need to be connected somehow. Sometimes that means plugging into USB, but increasingly it’s wireless, and introducing wireless into these applications takes designers up to a systems engineering level where you have to engineer the whole device in one shot and that’s a real challenge for many designers trying to engineer everything together at once.

Andreas Heldwein (Director, Business Line Medical, ZMD): As devices have become portable and battery operated, we see oftentimes that the power consumption is pushed down more and more into the low microamps or even nanoamps for standby power.

Also we see that the board space becomes more and more critical as the devices become smaller and smaller, so the integration level actually has to go up. You try to look at the board and the system level and see what components you can integrate. So you usually come up with more and more integrated solutions that also then are completely optimized for size and power consumption.

Paul Errico (Strategic Marketing Manager Healthcare Segment Team, Analog Devices): I echo Todd’s and Andreas’s comments that integration and size is becoming critical, so integration to reduce the board area is essential.

Portability requires maximizing battery life by reducing power consumption. Being untethered requires wireless communications and offering robust transceiver performance. As these devices get miniature, it’s not as if you can compromise performance and reliability and accuracy. So the challenge is to make sure that you’re still maintaining the highest level of performance that these devices have to offer, especially if they are being used as a diagnostic tool.

Miniaturization can require unique types of interfaces that can eliminate buttons or displays in the traditional sense. Capacitors to digital converters are used to create unique user interfaces.

Miniaturization still requires you to support a rich I/O feature set and processing power to support a real-time interface.

Scott Harris (Applications Engineer for Medical Products, AVX): I’d just like to ditto my colleagues’ comments, but also one of the things we’re seeing is increasing the requirement for more functionality, especially in the portable devices or the implantable devices. As these devices get smaller and more integrated, EMI, RFI, electromagnetic interference issues, radio frequency interference issues, and compliance to those standards becomes more and more of a challenge and more important.

Also protecting some of these circuits from accidental shock or other issues that could come into play is becoming more of an issue for these designs than they have in the past. Reliability is an especially important concern on the implantable side. Reliability and long-term life is becoming a very key thing for a lot of these suppliers and we’re seeing a lot of that in the market place as well.

Peter Resca (Director of Engineering, Astrodyne ): I think from the power supply side certainly on the portability and on battery operated, untethered as mentioned, we certainly see low power consumption as being an important driver there. On the other side, and at times it’s the battery charging side. What we see from customers is one of two things:

One, they either take the power external and incorporate an external adapter. We’ve seen more of that in the medical arena. Or on the internal side, what we’ve seen is a lot of — and this sort of echoes what Todd said about systems engineering — getting involved with the customers earlier so that the power supply can provide the EMC support and meet the EMC regulations which maybe in the past have been carried by an external filter or an additional filter and also the isolation barrier which in the past maybe was carried by an external transformer, further reducing the overall footprint.

Barbara Weisinger (Director of Marketing for Potentiometers and Sensors, BI Technologies): We’re a component manufacturer, so we don’t tend to get into a larger system, but on the component side, what we’re finding is that even though much of the equipment is using touchscreen and digital interfaces, there’s still a need for analog controls to provide immediate touch, like a pushbutton and operator interface where the user needs to “feel” something happening.

What we’re finding in smaller-size components is to be able to accomplish the same functions in a miniature unit — something that used to be one inch is now a half inch or smaller configuration for encoders and potentiometers.

We also have a division of our company that does thin-film devices that go into medical implantables, and they are required to undergo pulse-testing at a higher level than a normal thin-film electronic device, especially in defibrillator applications.

With this trend we are seeing customers come back to us on different equipment, to look at the interface — even a consumer interface — where somebody has to be able to intuitively know how to use a piece of equipment in a quick manner, versus something that requires medical training.

We’re seeing a lot of customers coming to us and asking for us to do something special, in some cases putting a switch in an encoder so that it actually has a function where they can single-touch it and know they’ve actually made the device work, versus sometimes on a touchscreen they often times are not getting quite the reaction from the device. Someone who is a consumer-product-type person using it or even a technician needs to feel that the device is on even when they can’t look at the equipment. They just have to know by feel what it’s doing.

John Di Cristina (Director of Strategic Marketing, Maxim Integrated Products): What we’ve been seeing is a push for smaller and denser packages, whether it’s a high level of integration or simple standard products in small packages. We’ve been seeing requests for advanced packages like WLP- and BGA-type packages. But you still have to have the same type of quality and reliability with these packages as with older proven packages which is especially true if it’s a portable product that needs to withstand drops and temperature cycles as well.

And as far as on the connectivity side, we’ve been seeing the requests for a lot of standard-type interfaces where in the past it’s been proprietary. Either wired or wireless interfaces have been trending toward either USB for the wired or some standard kind of wireless such as Bluetooth or ZigBee.

Electronic Products: What technologies — current and future — are available?

Todd Schneider: In terms of the technologies that are available today, there’s actually many good points that were just made.

I think we’re seeing a move towards smaller-geometry semiconductor technology to address the levels of integration that people need. For example, we have a range of low-powered DSP technology that’s been widely deployed in hearing aid and similar devices. We’re finding that technology moving into the portable medical space.

One thing that we’re seeing more and more are dual-core systems, ultra-low-power reconfigurable application specific processors and SoCs targeted at specific applications — systems with one general-purpose core and one application-specific core; so again very high levels of integration leading to very small dense packages for portable medical applications.

In terms of wireless, it was mentioned by someone that there’s movement from proprietary solutions towards standards. We see that as well. In the medical space there’s debate now on MICS versus MED Radio for implantable and body-worn applications. But I think beyond that people are looking at many solutions, especially ultra-low-power Bluetooth.

The other part that comes into all of this is that when you produce this complex technology and hand it to someone and say “you need to design this in“ — there’s a whole support infrastructure and ecosystem that has to go around that. So you need a solutions engineering center. You might need online design tools if you’re going to have programmable devices. You need a very capable software environment and things like that.

So there’s a whole support environment that kind of goes around all these complex technologies as well as all the usual technical elements.

Andreas Heldwein: At ZMD we have done a lot of work around sensor interfaces and over the years have developed specific low-power processor IP that allows the user to integrate their own signal conditioning algorithms — coming up with exactly the sensor interface solution our customers need. Also we always try to work together with customers. I’m sure everyone else on the phone does the same to figure out exactly what the customer needs. You need to see if there is one or another component that you can integrate. Something that we see very often used in the sensor interface area is that you move over to ratiometric systems where you work off an unregulated power supply to make the board even smaller by losing another component that doesn’t do much more than consume power. So we always look at solutions where you can come up with an application specific architecture to help our customers get exactly what they need.

Paul Errico: We certainly see the requirement for higher levels of integration. For example, in portable ultrasound you have a need for increased numbers of channels in terms of the low-noise amplifier, time gain amplifier, anti-aliasing filters and high-speed A/D converters.

An excellent product example is the AD9271, which includes eight complete channels of processing in a single IC that meets the low power consumption of next-generation portable ultrasound systems. It’s definitely a trend not only in ultrasound, but in many other areas where customers are looking to provide high levels of integration of mixed-signal components.

Extending the battery life while also trying to maintain the high level of precision and performance in these kinds of miniaturized diagnostic systems requires precision amplifier circuits that can support extremely low power consumption, 1-µA quiescent current and even less in shut-down and power-down modes, along with, of course, the whole assortment of low power data converters.

In terms of power management, we see certainly a need for our precision low-power LDOs. Our MEMS technology is enabling new capabilities in miniaturized systems such as activity monitoring, or to enhance the performance and measurement accuracy. New human interfaces are beginning to evolve quite dramatically.

The iPhone-type interface is really beginning to explode and being able to offer a sealed environment where you can now have a device that can be washed and there are no buttons, which increases reliability and safety.

Passive micro components

Scott Harris: I think we’re running on a common theme here. Integration seems to be the way the market’s moving today and also in the future. We’re certainly seeing that as well.

Obviously we’re a passive manufacturer, but we supply things like microminiature filters composed of multiple passive component technologies as well as single elements. Now we’re moving into multiple array filter connectors and integrated filter assemblies that combine several passive functions. We are seeing a move in the industry towards what we call passive micro components, which is similar to what the MEMS’s technology is except it’s an integration of passive solutions where we can reduce the size of a customers circuit all onto one tiny substrate and still offer enhanced performance with tighter tolerances and precise filtering which address a lot of the reliability issues, some of the agency issues on electromagnetic interference or RF interference or just safety issues all together and still provide a very, very tiny passage in what the customer and what the end users are looking for.

So that’s certainly one of the areas that we’ve been looking, we’ve been growing in as well as offering higher values in certain capacitor technologies and to address some of the things that the power supply guys are trying to work with as well.

Peter Resca: What we’re doing on the power side is certainly incorporating a lot of efforts of other people on this call at the component level. So we’re taking advantage of the smaller packages and the increased complexity in the filter elements as some of the passive people and bringing those into the power supply.

So that’s, you know, one of the major areas where we can try to reduce the overall footprint.

The second thing I would say on the power side is for the medical arena their incorporating, or we’re incorporating, a lot more higher-efficiency topologies which traditionally can be more complex and sometimes more costly. But the advantage in terms of size and the overall reduced dissipation that they create in the higher-efficiency-version topologies becomes attractive for the market.

Barbara Wiesinger: With the passive products that we have, the technology in some cases is seemingly older – potentiometers and encoders, for example. What we’re finding is that with our ability to seal units in the smaller miniature packages, that we’ll also be able to integrate different technologies together in a package for our customers looking to miniaturize, especially in ultrasound where we actually combine a potentiometer and encoder together in one package that used to be a lot larger size, and is now reduced from a two-inch- or three-inch-long product down to maybe an inch or less.

The advantage of what we do is that we’re allowing for absolute position. We don’t have the RFI issues with our products and, with absolute position being available in a combined package, this has given our customers an advantage, particularly if they’re trying to reduce size of even the larger more stable medical equipment in the field. We’re finding that their whole geometry as far as where we’re placed, they’ve been able to reduce size down a board that was 12 inches at one time, is now down to six inches or less and the interface between our products and then the rest of the board. Because we’re able to offer the absolute position, it takes away some of the other types of technologies, such as LVDTs, which would require us to have additional electronics in order to get back to an absolute position.

John Di Cristina: As far as Maxim is concerned, we have a broad product line from micro controllers, amplifiers, power supplies, RS-232 and a lot of interface products to communications products. There’s the ability to integrate these products or if their not on a common process technology there’s also the ability to put multiple die in a single package. So there are a lot of IP cores that Maxim has that we can leverage and either integrate together or package together in small packages.

And the other area that I think that is important to look at is lowering the power consumption. With portable applications you have to engineer it either to run directly off of a battery if it’s a simple system, like a glucose meter or to lower the total power consumption in other ways. If it’s a medical ultrasound system, then lowering the power is critical with the increasing number of channels and the migration to portable and handheld devices.

Electronic Products: How does the regulatory process impact the design process and are there ways it can be minimized to allow products to come to the market more quickly?

Todd Schneider: At ON Semiconductor, things broadly split into large volumes of standard products or custom products. For standard products we’re a very broad line supplier. These components are well specified and understood by designers. People get the datasheets, they can design them in and so on.

However, if you’re talking about our custom business, there we can get into some high-complexity and high-reliability applications. There are certainly good standards like ISO13485 that many companies are certified to.

The specific need you must address results from the customer’s need that you serve. So, for example, if you’re doing custom design for them we have a large custom business doing fairly complex devices you know they want to have good design history files, because you may need to supply that information to the FDA at some point.

So I think it really depends on the type of market that you’re in and the scope of what you’re doing. We also occasionally get into doing software development and there, standards like IEC 62304 give you a process that’s compliant with FDA guidance.

For many high-reliability designs we, as a matter of course, will do a DFMEA, a Design Failure Mode Effect Analysis, and there again we have a long history and background in these techniques that originated in the automotive space.

So there are a wide range of processes and techniques and I’d say that in many cases what we do is we rely on our high-reliability and high-quality background that we have from our work in automotive, aerospace and military applications, bringing that forward into the medical area where you work towards new standards.

What is going on in Europe?

Andreas Heldwein: Yes, well definitely being over here in Europe it’s again a little bit different than from what Todd described.

Europe used to be a little bit limping behind when it came to regulations, but there have been some regulations that started over here in the ‘90s. Now a lot of them have been reworked and a lot of the U.S. regulations have been used as models. So they now are now regulating active and implantable medical devices, which are pretty much, I think applications every one of us here on the phone is interested. Because that’s what we design into and that’s what our customers do. It’s best that we as suppliers then start thinking in our customers terms to see, well, what regulatory terms there are when it comes to documentation.

Just like Todd said, you know, it really helps when companies have automotive background because a lot of the automotive technologies evolve around being able to documenting them, making failure analysis, running different qualification processes, and pretty much being able to hand over binders of documentation paperwork.

A lot of that is now implemented in medical applications. So it helps to have that automotive background. But what’s always very important is that you exactly identify your customer — who is most likely the one that will do all the regulatory compliance related work — what application exactly it is that you go into, a lot of times you have to define the parameters you are required to document, and how you need to design. You need to have a clear definition of what your customer then expects from you. So communication and of course you as a semiconductor or component supplier making yourself familiar with all the different regulatory requirements are key.

Electronic Products: So it’s not only communicating with your customer, but also you need to communicate with healthcare professionals and the regulatory agencies?

Andreas Heldwein: Maybe even as far as the agencies. Some of the products were implantables where we’ve had to go as far providing documentation directly to the agencies.

Paul Errico: There’s no doubt that, with the proliferation of the products that are now being developed for the medical market, the FDA is receiving pressure to protect patients from potentially unsafe devices. Increased regulatory scrutiny is happening.

But from the customer’s prospective, they need to develop robust solutions, so they require high-quality application design support to ensure that their FDA certification process progresses without compromising system performance.

We’re offering products that are meeting FDA requirements like the IEC60601-1 for our iCoupler isolation products.

Medical products are in production for many, many years. Customers work with us because they know Analog has a 40-year history in the semiconductor market offering products across many different technologies and processes that we support for many years. Sustainability is required because obviously you know when you start making component changes in the development process or in the production process it will require additional FDA work and that’s not something that customers want to do.

Scott Harris: Well, for us communication is essential. We really need to understand how these parts are going to be used and what kind of applications they are going to be going in. But, of course, along with that reliability and performance is also an underlying and driving factor.

We work with the regulatory agencies and alongside the customers on identifying all the needs and requirements. We are very fortunate in that we have a lot of history with a lot of these customers so there’s a lot of data that has been established. In addition to this, we have other divisions that support other high-reliability backgrounds such as space, military, and automotive. We established an internal medical qualification that represented the toughest parts of these requirements. It sets a higher standard for components and gives our customers a very comfortable feeling in terms of reliability of what we’re going to provide especially if it’s going to be in an implantable situation or a life sustaining situation that people just need that extra degree of flexibility.

So we have a long-term effort in that and plan on continuing to move that forward.

Peter Resca: How we support our customers, and I think facilitate their regulatory approvals, is first and foremost by complying with the medical standards as referenced earlier, the 60601-1 and also the 60601-1-2 which is the EMC collateral standard and by carrying those certifications and the appropriate documentation and support that go with it, that seems to be our best method of facilitating the end customers regulatory approvals.

Barbara Wiesinger: Basically, listening to everybody, I think we’re all approaching the market and our customers the same way.

We’re heavily automotive. We are TS16949 approved and echoing what has been said, having the background in the medical field and having a very good established customer list in that area is important. Also, being an automotive supplier and a mil/aero house, we have the control plans available the DFMEA, the TFMEA, and all the different types of testing that we do for automotive carries into the medical side.

Having all the documentation available, but then what we find is so much of what we have, we have a very broad standard product line. What we’re finding is a lot of our medical customers are coming to us and they want to go closely (like the government) to a cost type of thing or an off the shelf type of product, obviously to get costs downs, but then they also need the high reliability in the medical and automotive applications.

And so what we’ve found is we’re able to do a combination making a set product to a customer drawing and our customers can use it because we’re at the component level. So they are the ones who write the spec, usually in their drawing to us, that we sometimes either receive from them directly or in conjunction with them. They are the ones that tell us what the testing is going to be.

In many cases, they take a system and actually go into testing based on the history of the part that we can give them with the control. So we don’t see quite the type of testing that somebody at a systems or that a power supply would have to go through because we’re a part of the power supply or we’re part of the system.

John Di Cristina: Certainly our customers require a high level of quality from our products and that includes the documentation that goes along with them. I think this has been said by other people, but listening to the customer regarding their application and what their product needs are is very important and if issues arise either during design or production then the key is to give them good support as far as whether it’s a failure analysis or looking into other types of problems such as design practices regarding using the device or the board layout.

Products used by patients

Electronic Products: We touched a bit on implantables and current products being used by a patient. Are there different issues a designers needs to address compared to when designing medical products used by professionals?

Todd Schneider: We’ve actually looked at this, because we do a lot of early marketing work, looking at where applications like this are going. The major thing that we’ve observed is that when you’re designing a product that will be used by the patient, you have to remember that the person using it is not a healthcare professional and they are unlikely to be trained in anything like that.

The other thing is that they’re often going to be an elderly person. So think about a blood glucose meter. In a situation like this, the person may be somewhat elderly, they may have low vision because that often gets paired with diabetes and so from a design standpoint, the designer has to think about it in a use case model where they’re looking at it saying “what are all the issues going on with this person,” so you’re not designing it as single point solution where we just have to measure some electrochemical reaction off the glucose meter finger strip and you’re done.

Designers really have to think more broadly about what the device does and what features come into the use cases. If I’m going to make it easy to use, well I want a nice big display, I need a big bright backlight — then you’re down into the whole issue of power management and batteries. So you really have to come at it from a very broad systems level solution approach and then determine the combination of products that will be put together to achieve the goal.

The other area we talked a little bit about was untethered devices and the whole wireless issue. Deploying technology like this into the home situation brings about questions on infrastructure, reliability, safety, etc., which Peter has already mentioned a few times. There are a lot of issues there that you really need to think about. You need to think about the user that’s going to be using this product because you can have the coolest technology in the world but if you don’t solve the person’s real problem you’re not going to sell very many products.

So I think that designers need to “pull-up a level” to consider how devices will be used and I think a lot of them do. As an example, we see many designers who take a holistic approach to looking at power management for medical devices. Power management is a big area where ON Semiconductor is deeply involved; we have a lot of great products there. ESD protection is another area of concern for these devices because they have to work reliably all the time in the home environment and provide the kind of assistance that meets the users need.

Does that answer your question?

Electronic Products: Yes, it does. The reason I mention this is because my dad uses the same glucose meter for the longest time and it’s kind of dirty/dusty on the top of the sensor. He never cleans it, so I wonder if his measurements are accurate. Do you as the designer take this into consideration?

Todd Schneider: That’s a great point and I think it was mentioned by someone earlier — it might have been Barbara — that you need to wash products. People want a glucose meter that’s like an iPod. Well there’s a little bit of a problem with that, it’s because if you pricked your finger you have blood on your finger. And if that gets on the screen it can mess it up. So you can’t just deploy these technologies without thinking about the fact that you know someone is going to have something on their finger and their going to be trying to work our touchscreen. So you might need another technology like an acoustic touchscreen, which is an area where we’ve been working with a partner. So you have to look at this and think how is this thing going to be used and what problem are we trying to solve and make sure it’s going to work.

Andreas Heldwein: Some of those consumer medical applications the name says it already become more consumer like. As the volume goes up, the manufacturers experience price pressures similar to what is happening in the consumer market. Yet, the user still has to expect a device that when he takes it home still works like a medical device. To be prepared for the medical market and to understand which applications are subject to higher or lower price pressure, you have to understand a little bit more how the healthcare system works. For instance it becomes important to understand how healthcare expenses are reimbursed differently in European countries and the U.S.

So you have to differentiate between the rugged, interoperable, built to last professional device and the reliable, cost-driven consumer medical applications.

Paul Errico: Analog Devices is a member of the Continua Alliance. The goals of the Continua Alliance are to address some of these consumer medical applications and insure interoperability of these various devices that are going to end up in the home. Whether it’s a glucose meter or some sort of a patient monitoring device or digital thermometer, the list just goes on and on.

The Continua Alliance pulls together everyone from the suppliers of medical devices, silicon suppliers, system suppliers, even insurance organizations.

Scott Harris: Yes, for sure the consumer aspect of it brings in a whole new set of issues. Quite often we see that some of the reliability and even the ESD susceptibility issues are sometimes overlooked because it is a consumer device and that brings up a lot of failures from the field because people aren’t protecting the device. It gets dropped into a drawer, kicked on the floor and can definitely have some issues that are not present in the hospital or laboratory environment.

Sometimes it’s more difficult to design these devices for consumer applications because of how they are treated versus in a hospital where they are rolling around on wheels and always treated and cleaned properly and things like that, so the home use definitely provides a lot of difficult design considerations that need to happen.

People don’t want to pay a lot for these devices, but they have to rely on these devices and if it’s an implantable device then it’s even that more essential, that you’ve got to have a reliable device. People are counting on these pacemakers to restart their heart at home or to keep pacing their heart or control a neurological issue via a bion. The last thing you want to do is open that person back up. Depending on the device and technology, those types of issues are magnified 10 times versus what they are in a hospital.

Peter Resca: It’s interesting because actually in working with the customers, sometimes the hospital environment actually can be rough too.

But as we work with customers and look at sort of the home care market, a couple of things. In some cases, when we work with them, the external adapters similar to a laptop or a cell phone become advantageous depending upon the set of customers that are used there applying it for. In other cases where the power supply is internal, it was sort of mentioned earlier that misuse scenario becomes very important, “you know what happens if?”.

What happens if the fans blocked or what happens if the cords are kicked out. Those different types of scenarios start to become critical because you have a patient that’s at home, by themselves and you want to make sure it’s user friendly. Both from the interface point of view and also from just general operability. So I think that’s a couple of the big things we see.

Barbara Weisinger: Well, I alluded to it in the first question in the intuitive use and how something feels. We’re seeing a trend shift — right now the type of product that we’re working with and that’s being requested is that it has an actual feel to it. That they can turn it or push it and they, especially on the consumer end, actually feel it working.

So in looking at the age group of the people that are using the equipment today or that’s being developed today for in home use, that’s more intuitive, that it has to be where they feel comfortable using that type of device.

What we’re seeing and this goes back to the touchscreen and some of the methods that we’re getting used to, especially in the younger generation — is that they’re looking ahead and saying there’s almost a cutoff point to where the analog feel isn’t quite as important anymore because everybody who’s in the younger generation is coming up and knows touchscreen. They are very comfortable with it and so therefore, we’re starting to see a trend shift from what we’re doing today to what they’re expecting to do in the next 5 to 10 years as far as the equipment and what’s it’s going to look like.

On the acoustic side, we’ve heard a lot about the voice recognition and actually being able to be interactive in that method, to take away even some of the touchscreen and/or push panel, type of pushing button, because that’s the easiest method (if it’s made reliable) to work with this equipment for people who don’t have the training or background for it and so we’re seeing a shift there.

It’s not there yet, but we are starting to see that shift from the designers of the equipment telling us this is where the trend is going.

John Di Cristina: As far as products that are designed for the home use, you definitely have to take into account the level of skill and the type of user and I think a lot of these people that make products for home consumer medical products are definitely adverse to putting too much technology and making them too difficult to use.

Like it’s been said before they have to be reliable, they have to be easy to use, they have to last a many years in many cases. Sometimes they throw the glucose meter in a drawer for a year, then they start using it again, so there’s a lot of things that go into making it easy to use. They have to also think about what can go wrong to prevent erroneous results. Having said that, there is a push to try to get all these devices connected together, and with the Continua Alliance and other types of initiatives the trick is to do this and still make the devices robust and easy to use. But there definitely is a push to do that in the future. ■