Winning the Shire ADHD Challenge: 6 Clinical Trial Innovation Takeaways

In January of 2013, I embarked on a project that would culminate about 9 months later (no, not that kind of project) in Santa Clara, CA on the Health 2.0 conference stage.

The project was Traxion, an ADHD mobile app that Rebar Interactive developed in collaboration with Omniscience Mobile.

Traxion was created as a submission to a Shire / Health 2.0 developer challenge. The goal of the challenge was to develop a technology-driven solution to aid individuals with ADHD during their transition from adolescence into adulthood.

On October 2 at the Health 2.0 conference, Traxion was announced as the 1st place challenge winner. Our prize was $100,000 and the opportunity to demo Traxion for Health 2.0 conference attendees.

If you’d like to learn more about Traxion, check out our demo video:

Traxion – ADHD Running your life? from Rebar Interactive on Vimeo.

Needless to say, I’m very happy with the outcome of this project. Winning is great. But I found the experience itself, regardless of outcome, very valuable and rewarding.

Below I’ll share 6 clinical trial innovation takeaways from my experience.

It’s no secret that in order to survive, pharma will have to innovate. Here are my thoughts on some ways to do that.

1. Think different with mobile.

Many in pharma are interested in “beyond the pill” strategy, and mobile apps are often central to these discussions.

Though I had a good appreciation for mobile’s uniqueness prior to my work on Traxion, that appreciation deepened during development.

Let’s count the ways.

Feature possibilities

Some desktop features are not available with mobile. And some mobile features are not available with desktop. These differences are essential to understand because feature possibilities guide product possibilities.

For example, Apple’s iPhone 5s has a “motion coprocessor,” which will allow apps to detect whether users are at rest, walking, or driving. This mobile processor enables a host of potential new applications, particularly in healthcare.

User interaction

Perhaps one of the most intuitive and ubiquitous mobile user interactions is “pinch to zoom.” Had mobile designers confined themselves to a desktop mentality, our zooming experience would be far clunkier today.

Mobile development requires familiarity with common mobile-specific user interactions like “pinch to zoom.” Furthermore, it requires detachment from a desktop design mentality.

Level of intimacy

According to Pew Internet, 44% of mobile phone owners have slept with their phone next to their bed. For those 18-29 years old, this number is 83%.

To paraphrase the Golden Girls theme song, our mobile phones have become a pal and a confidant. As a result, mobile phones provide extraordinary access to users.

User expectations

This greater intimacy comes at a price, however. And that price is great expectations.

Users expect apps to be intuitive and easy to learn. Users expect apps to provide maximum value for minimal time investment. Users expect apps to be engaging and even playful. And users expect apps to cost little or nothing.

The intimacy of mobile is not automatic. Rather, mobile user interest and loyalty must be earned (and it’s not easy).

The Bottom Line

Mobile’s uniqueness affects everything, including design, user acquisition/retention, and business models. Perhaps most importantly, mobile leaves little room for error.

Takeaway 1: Just about everything is different with mobile, which means you must be prepared to think and do differently.

2. Embrace constraints.

Our natural inclination is to fight constraints. But in my experience, constraints are the mother of invention and creativity.

Twitter is one of my favorite examples of how constraints can ultimately free us. What can you possibly say in 140 characters? As it turns out, a lot. I’ve been tweeting for over 5 years, and I continue to be regularly amazed and entertained by the creativity people exhibit in so few characters.

My work on Traxion has reinforced this appreciation for constraints. For example, constraints we encountered include:

• The small screen sizes of mobile
• An app requiring attention from those prone to distraction (young adults with ADHD)
• No experience creating an app for a specific therapeutic indication
• The fact that this was a side project outside of our core business
• Limited resources (time and money)
• An aggressive and unforgiving deadline

Constraints forced our team to intently focus on what was really important. In my view, this forced focus helped us to make a stronger app.

For many years pharma has had the resources to (successfully) fight constraints. This ability may have been good for short-term profit, but I suspect it has been detrimental to long-term viability and relevancy.

By fighting rather than embracing constraints, pharma has limited its ability to tap into creative breakthroughs that might have led to transformative innovation.

Pharma is increasingly being forced to deal with constraints, whether it wants to or not. But why wait for the inevitable? Try imposing constraints (even if artificial) and see what breakthroughs occur.

Dr. Seuss wrote The Cat in the Hat with only 236 different words, so his editor bet him he couldn’t write a book with only 50 different words. The result of that bet was Green Eggs and Ham, one of the bestselling children’s books of all time.

What if you had to do a clinical trial with a fraction of the money, time, and people than you are accustomed? How would you conduct that trial?

Takeaway 2: Constraints can lead to breakthroughs, so embrace them even if that means imposing them artificially.

3. Prioritize the patient.

Patient engagement. Patient centricity. We’ve all heard the buzz.

But to borrow from Ben Harper lyrics, these buzzwords are so hard to do and so easy to say.

Know Your Audience

During the development of Traxion, we did countless hours of research. I believe this research was key in elevating the quality of our app and generating interest from ADHD young adults.

Here’s some of the steps involved in our quest to truly understand the target patient population.

• Studying literature published by experts in adolescent ADHD
• Sifting through ADHD online resources and social conversations
• Interviewing ADHD academics, clinicians, coaches, parents, and patients
• Gathering feedback on our initial Traxion wireframes during focus groups with ADHD students at the University of Central Arkansas. (Shoutout and big thanks to Julie Meaux for helping us with this)
• Creating a pre-launch website to gather ADHD beta testers (currently at about 600)

Though research requires a lot of time and energy to do well, I’d argue it’s the easy part of prioritizing patients. Commitment to patient engagement and centricity is really tested during product design.

Design for the Patient

And this commitment will be tested repeatedly.

• When your product needs and desires conflict with those of the patient, what will you do?
• When internal stakeholders lobby for their pet interests, will you protect patient interests?
• When you are making decisions, will patient feedback be included in that process?

Here’s an example of one test of our commitment to patient engagement and centricity. Many factors can affect ADHD symptoms, including diet, exercise, and sleep. Our team really wanted to capture data related to these factors and provide it to the patient in a useful manner.

But then we considered whether our users would view this functionality as burdensome. Our conclusion was yes, and we opted to suppress our greedy data desires. Though this data would be useful to the patient in theory, the app would be useless to the patient if not used in actuality.

The work of prioritizing the patient is never really done, as is the case with Traxion.

To be clear, I’m not saying that the patient perspective always trumps everything. But the patient perspective should have far far more weight than pharma has given it in the past. This reality is particularly glaring in clinical trials, which are often downright patient unfriendly.

Takeaway 3: Patients are a key determinant of success, so prioritize their needs and desires.

4. Focus on design.

Traxion’s success hinged on our ability to hold the attention of those with little to give.

So we put much thought into how best to engage our easily-distracted users. The biggest focus of this thought related to design. We believed that design was pivotal to engaging our audience.

Design is not just about making things look pretty. So what is it? I really like Seth Godin’s description in a recent blog post.

…The goal is to create design that takes the user’s long-term needs and desires into account, and helps him focus his attention and goals on accomplishing something worthwhile…That well-designed prescription bottle, for example, is well-designed because it gets you to take your medicine even when you forget or don’t feel like it. If that wasn’t the goal, then a cheap Baggie would do the job…Great design is pushing/focusing the user to do something that he’ll thank you for later…Great designers can easily answer the question, “what do you want the user to do?”

In the past people have tolerated bad design. But that tolerance is waning.

Even Google, which historically was almost hostile to design, has taken note of design’s growing importance and power. So we should probably take note too.

Under the leadership of Larry Page, design has become a company-wide priority. And this focus is really starting to show in the quality of Google’s products (e.g. Google Maps). If you’re interested in Google’s transition from design weak to design strong, Fast Company has a great article on the topic: How Google Taught Itself Good Design.

While developing Traxion, our audience’s condition necessitated that we focus on holding their attention. But that focus should not be limited to audiences with ADHD. No matter who your audience, it’s worth assuming their attention is limited. Because most of the time, it is.

We live in an increasingly fast-paced information-overloaded world. Thoughtful design is essential to capturing the little mental space or energy that people have to give.

As a clinical trial professional, I can’t help but think of design in clinical trial terms. And the design of clinical trials, as a model and a product, is severely lacking. I believe improvement on this front is the single best thing we can do to relieve the patient recruitment bottleneck.

Takeaway 4: Thoughtful and engaging design will hold your audience’s attention, making it a powerful competitive differentiator.

5. Be curious.

Prior to the Shire challenge, I had taken a Human Computer Interaction and a Gamification class on Coursera. And I had also closely followed the work of behavioral health and persuasive technology experts like BJ Fogg. This learning had some relevance to clinical trials, but it was a bit outside of my immediate professional focus.

I spent time studying these topics because of a natural curiosity. At the time, I did not know if this knowledge would prove useful to future projects. But it turned out to be extremely helpful during development of Traxion.

It was in the Human Computer Interaction class, for example, that I learned:

• How to rapidly prototype and evaluate interface alternatives
• Principles of perception and cognition that inform effective interaction design

Had I focused my learning exclusively on “professional development” topics in clinical trials and patient recruitment, I would have been far less prepared for this project. At the same time, my professional expertise in the digital marketing of clinical trials proved useful even though this project was outside of the clinical trial domain.

Knowledge and ideas from a variety of areas melded together in a favorable manner.

Careers across all industries are becoming more specialized, which means our knowledge must be specialized too. But this specialization can have negative consequences (or as we prefer to call them in clinical trials…adverse events). In particular, over-specialization of knowledge creates rigid thinking. This rigidity is especially problematic during times of rapid and significant change, as we are experiencing now in pharma.

Henry Ford drew inspiration from Chicago’s meatpacking operations when developing the assembly line for the Model T. The assembly line made cars affordable for average Americans and raised the standard of living nationwide.

By being exposed to knowledge and ideas in disparate areas, we open ourselves up to new perspectives and creative solutions.

It’s not enough to cultivate depth of knowledge. We must also cultivate breadth.

Takeaway 5: Expose yourself to knowledge and ideas in a variety of areas, and good things are bound to happen.

6. Go on tangents.

This last takeaway is very intertwined with the previous but deserving of its own mention.

In a Steve Jobs commencement address (which I highly recommend watching, right along with that of David Foster Wallace), Jobs tells three stories from his life, each of which supports a larger message.

In the first story, Jobs described how he dropped out of Reed College and began sitting in on classes that interested him. None of these classes, at that time, seemed to have any practical implications in his life.

As Jobs put it, following “curiosity and intuition turned out to be priceless later on.”

One of the classes Jobs sat in on was a calligraphy class. Ten years later, Jobs applied that knowledge when developing the first Mac computer.

Because Steve Jobs dropped out of college and sat in on a calligraphy class, computers have the beautiful typography that they do today.

Again, you can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.

I tend to have a similar philosophy. This philosophy is what led me to consider participation in the Shire challenge. I could have easily (and logically) dismissed the possibility because it was outside of Rebar Interactive’s core business in clinical trials. But the Shire challenge excited me for several reasons, so I went ahead and entered.

Traxion was and remains a side project.

I have some sense how this project might connect with my other work, but the picture has yet to fully unfold. As Jobs said, I’ll really only be able to connect the dots looking backwards. And really, that’s part of the fun.

Jobs’ story about connecting the dots was about his personal path, but the lesson can be applied to organizations as well.

Being strategic is good. But I think there is such a thing as being too strategic. By overly focusing on a particular organizational path, you create blinders that remove the ability to recognize innovation opportunities beyond your imagination.

I suspect that truly breakthrough innovation in pharma will come in a way that no one, not even the innovator, would have predicted. If pharma is to be the innovator, we’ll need to provide the space and flexibility for that to happen.

Takeaway 6: If you are willing to go on tangents, those tangents may turn out to be your organization’s next big innovation.

Summary of 6

Here’s the full list of 6 innovation takeaways from my Shire ADHD challenge experience. I hope that by sharing these, others interested in pharma innovation will find some inspiration. And I hope that you’ll share some of your own innovation takeaways in the comments.

Image Credits:

Frank Lloyd Wright – Wikipedia
Golden Girls – Wikipedia
Ben Harper – Wikipedia
Seth Godin – Wikipedia
Henry Ford – Wikipedia
Steve Jobs – Wikipedia