Licking the challenges of a unique medical app

How this software firm streamlined an app that lets sleep apnea patients and their doctors control electrodes implanted under the tongue.

By Tony Fienman, Sanctuary Software Studio

This app for configuring a sleep apnea therapy’s electrode implants used a circular workflow to simplify the process.  [Image courtesy of Sancsoft Software Studio]

Say you’re developing an app that works in conjunction with bleeding edge medical technology. You might feel the need to hold your tongue about it. But when the app will literally control the movements of a human tongue as a novel solution for sleep apnea, you might be inclined to talk about it.

This is the case with a recent project undertaken by Sanctuary Software Studio. A development-stage medical technology manufacturer built a tool based on a highly complex matrix that enabled clinicians (and later patients themselves) to fine-tune nodes implanted under the tongue. Sanctuary’s role was boiling down all that complexity and distilling it into a simple, intuitive user interface that would accelerate clinical decision-making and patient outcomes.

That elegant UI became the special sauce in a project that brought together surgery, medical device implantation, Bluetooth connectivity, clinician control, and patient interface.

A new treatment for sleep apnea

The patient-facing interface was intentionally simplified to reduce complexity and anxiety, providing only the essential controls within physician-defined safety limits. Visual cues and intuitive layout empower users to make precise, incremental adjustments at home, while keeping more advanced settings safely out of reach. A dimmed screen appropriately encourages bedside use and restful comfort. [Image courtesy of Sancsoft Software Studio]

One cause of sleep apnea is the tongue falling back into the airway. Our client’s solution carefully calibrates eight nodes implanted under the tongue to the patient’s unique nerve endings and musculature. These nodes sense when the tongue moves back into the airway and send electrical pulses to straighten it, thereby clearing the airway.

The eight nodes can be turned on or off at different frequencies and voltages via a mat under the patient’s pillow. That mat is controlled by a Bluetooth-linked app running on a tablet on the patient’s nightstand.

When the device was in development, the manufacturer created their own makeshift interface so physicians could test and calibrate the nodes after implantation. Geared toward an engineering audience, it was highly technical and not at all user friendly. Our challenge became preserving the tool’s functionality while transforming it into something immediately usable by both physicians and patients.

Sanctuary focused on creating a UI that served two vastly different users: first, physicians performing initial calibration, and then patients making small at-home adjustments within parameters set by their care team. The system also had to securely gatekeep access between user types.

Accelerating the tuning process

One of the most critical contributions was the creation of a workflow that drastically reduced the time and iteration required to tune the implant after surgical insertion.

Think of it like an eye exam where the doctor repeatedly asks whether lens one or two is better, dialing in your prescription. Now imagine if each of those tests was potentially physically painful. That’s what this implant tuning process is like.

Following implantation, the patient must return for clinical tuning. The physician adjusts voltage, frequency and electrode pairings to find the most effective and least uncomfortable muscle movement. Patients need stimulation that’s strong enough to work, but gentle enough not to wake them up.

The objective of the new user interface was to minimize the number of interactions needed to find that therapeutic sweet spot. No one should fumble through options or struggle to recall what they did last.

That’s why we built a circular workflow. The app guides users from top right to bottom right in a semi-circular sequence. When one step is complete, the next lights up. If a clinician forgets where they left off while responding to a patient’s feedback, for example, they can glance down and immediately see where to pick back up.

After this, thresholds are set so that the patient can increase voltage over time as they become accustomed to the implant. For safety, patients can only make adjustments in minute increments before requiring additional supervision by the doctor.

The clinician-facing interface enables fine-tuned control over each implanted node, allowing medical professionals to adjust voltage, frequency, and electrode pairings in real time. Sanctuary Software designed the workflow to minimize cognitive load and streamline the tuning process, guiding users step-by-step with visual cues that promote speed, accuracy and repeatability during clinical calibration. [Image courtesy of Sancsoft Software Studio]

A taste of things to come

Sanctuary developers used a time-tested process that would translate the highly technical engineering app into something useful for doctors and patients.

First, software engineers imagined the conditions under which the final app needs to work, who will be using it, and what their level of expertise will be. Next came creation of a flow chart plotting out the steps needed to accomplish the goal.

From a relatively high level of understanding, the process is broken down into smaller increments to eat the proverbial elephant one bite at a time.

The new interface was designed such that the patient’s right side matched the left side of the electrode set, because this is the way that the surgeon and follow-up physician (who control right/left dependent functions) present to the device. It eliminated any mental gymnastics of having to translate the sides, speeding up the fine-tuning and verification process. This differed significantly from their original prototype.

Then, sliding panels and a streamlined workflow were added to the app layout. Using visual cues by highlighting the areas and buttons that represented the next steps and keeping those next to the last step of the previous interaction, it created a circular workflow for repeated testing.

The diagram below illustrates the user interface (UI) workflow developed by Sanctuary Software Studio. The process began with a full deconstruction of the client’s original interface to isolate all functional components, followed by in-depth consultation to understand the principles of use from both clinician and patient perspectives, each requiring distinct interfaces. Key UI elements were then categorized into logical groups (global settings, localized controls, labels, warnings, etc.). The ultimate goal was to remap these elements into an intuitive, guided workflow optimized to streamline the tuning process and minimize user error, enabling precise and repeatable adjustments to stimulate tongue movement effectively.

[Image courtesy of Sancsoft Software Studio]

Elegant simplicity

The medical field constantly pushes software engineering partners to merge software and human-centered care. This was a perfect example. The client brought deep technical innovation to us. Our role was to simplify that complexity, to translate their engineering brilliance into a faster, safer and more usable tool for real-world caregivers and patients.

Ultimately, we helped reduce a complex chart to a set of buttons with intuitive interactions that resembled a radio tuner. This enabled faster settings in the physician-facing part of the app, reducing patient anxiety during the testing process. The patient-facing app screen is simplified and offers visual cues to guide them.

This merging of therapy with digital interactivity was achieved in two marathon bursts of activity that totaled approximately 160 man-hours. Human trials on the device are now underway in Australia.

Tony Fienman is the co-founder and creative director of Sanctuary Software Studio [Photo courtesy of Sanctuary Software Studio]

Tony Fienman is the co-founder and creative director of Sanctuary Software Studio, where he leads interface and experience design for safety-critical software applications across medical, aerospace, and industrial domains. With over three decades of experience in interactive media, he specializes in visual systems that reduce cognitive load and elevate user performance in mission-critical environments.

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The opinions expressed in this blog post are the author’s only and do not necessarily reflect those of Medical Design & Outsourcing or its employees.