Design Case Study: Transplant Hero

Transplant Hero is a medication reminder app that is the brainchild of Dr. Jay A. Graham, a transplant surgeon in New York. It helps transplant patients follow a strict anti-rejection medicine regimen after an organ transplantation. At Stanfy in collaboration with our client Dr. Graham we designed the iPhone app experience, created a name and a logo for the product, and finally brought the solution to the iOS marketplace.

In this post I would like to share with you our design process and lessons learned. Together, we put our whole collective heart and soul into this project and even if Transplant Hero can prevent one rejection — it was well worth it!

Understanding the problem

After an organ transplant, patients need to take immunosuppressant drugs that help prevent their immune systems from attacking the new organ. Typically, the drugs must be taken for the patients’ lifetimes, at all hours of the day and night from two to four times a day.

This creates a serious challenge for patients — research shows that 15% of graft losses happen due to immunosuppression non-compliance. In 2014 alone around 30 000 transplants were performed in the US. That means that around 4500 of them may have serious problems due to medication non-adherence.

Why are the numbers so high? Why do people whose lives depend on the tiny pills keep breaking their medication regimens and repeatedly forgetting to take pills on time? Why don’t existing reminder apps help?

Understanding the people

Our design process starts with the people we are designing for and ends with the solution that suits their needs. Research is a reliable way to gain insight into people’s’ lives and to create a compelling experience for them.

For this project we chose to conduct generative research with the goal of stepping into transplant patients’ shoes, to understand their lives and solve problems from their perspectives, and to to find answers to such questions as:

  • What is the exact problem we are solving?
  • Who are we building this for?
  • What is the context in which our users will interact with what we are designing?

The research included a series of informal interviews with patients and a subject matter expert (the transplant surgeon), and a review of existing literature.

We asked transplant patients about a variety of topics, including their lives before the surgery, how they changed after, difficulties they are experiencing in relation with their medication regimen, and their computer and mobile habits.

The interviews allowed us to get the following valuable insights:

  • The patient’s life is changing dramatically for the better within several weeks after the surgery.
  • Within weeks of leaving the hospital patients find that that they have more energy and the world has become “brighter”.
  • During the first several months patients feel overwhelmed with information; they need to learn about their new organ, how to take care about it, and how to avoid rejection and infection.
  • Patients hardly notice that they miss their anti-rejection medicine sometimes.
  • Transplant patients often treat the day of the surgery as their second birthday.
  • Patients do forget about taking their pills on time even though they fully realize that it may cause the rejection of their transplant organ.

Defining the vision

Our next step was to transform our research into meaningful and actionable insights that would become the foundation for the design.

At this stage we were looking for answers to these questions:

  • What should we make?
  • How should it work?
  • Why should people care?

We conducted several ideation sessions within the team and the client to make sense of what we learned and come up with experience and design principles for the product.

Experience Principles and Design Criteria

  • Transplant Hero is your smart guide to the anti-rejection medicine. It minimises the patient’s work on medications setup and does the heavy work on proper pill scheduling.
  • Be a friend, not a doctor. Transplant Hero builds a personal connection with the patients and encourages them to follow the medication regimen. By taking medications regularly a patient is rewarded by fun and cool awards.
  • Transplant Hero is all about transplant patients and their medications. It anticipates the medications needs of the transplant patients and content that is universal for the transplant patients is predefined.
  • Transplant Hero is the bright part of your post-transplant life. The application’s visual language emphasizes the new, energetic patient’s life, far away from a hospital.

The application inspires, encourages, and gently but persistently prompts patients about their medications times.

Designing the experience

Once we identified opportunities for design we started sketching out concepts quickly to illustrate the user experience with our app and prototype several possible experience solutions.

The Engagement Flow

A big part of our discussions was the “engagement flow”, the “secret sauce” of the Transplant Hero that is supposed to get patients to stick with the app and seamlessly, playfully help them to get used to keeping track of all of their medications.

Eventually we came up with the flow that involves the user in the game and challenges him to earn cool rewards towards eventually becoming a Transplant Super Hero.

Minimal Viable Product (MVP)

Our goal for the first release of the app was to design and develop a minimal viable version of the product that:

  • would cover the main user needs,
  • would engage users;
  • would be created with reasonable amount of efforts and investments;
  • allow us to gain feedback and learn how to improve the app.

We decided to focus on two basic uses:

Creating a design prototype

Following the design criteria that we agreed on before we came up with the user interface concept for the application.

Than we applied a little bit of color magic and here is our beautiful Transplant Hero!

Defining the key product metrics

“Don’t just ask questions. Know how the answers to the questions will change your behavior,” Alistair Croll stated in Lean Analytics.

The metrics that we will choose to track over time should help us to make design decisions and avoid unnecessary implementation efforts. Also the clear set of metrics allows us to indicate the progress of our product.

In Transplant Hero one of the most important goals is in the engagement category: we want our users to “checkin” all their meds every day. To identify this we need to calculate the ratio between checked in and prescribed medications.

Other information that is also important for us is understanding what stops patients from becoming our regular users. To do this we can track the retention rate, how many of the active users from a given time period are still present in some later time period.

The third issue that is important is the percentage of users who installed the app and successfully went through the medication setup flow. This can give us a hint about what turns off some users from the app at the very first launch (fears, questions they may have) and how we can improve that.

Key metrics:

  • Missed rate per active* user per week — the ratio between checked in and prescribed medications (by active user we mean a user who checked in at least one medication during the last 7 days)
  • Retention rate per user per week — percentage of users who are active after 7 days
  • Activation rate per user per week — percentage of users who successfully scheduled their medications

Build it. Learn. Iterate

In development we followed the Agile process and it took us about 5 one-week sprints to release the first version of the app.

The flexibility of Agile and the ability to test the app every week gave us a chance to improve the user experience and refine some ideas during the development cycle. As a result, the scope has grown but together with that it has allowed us to deliver a better product.

Almost immediately after the app went public we started to gather feedback from the early users and learn.

For example, together with the client we found out that the majority of the patients don’t religiously follow the doctor’s prescriptions and prefer to customize their medications schedule. Other patients have specific needs to schedule medications every other day or have different dosages in the morning and evening time.

This feedback contradicts our research findings and the design principles that we defined for the app — that the app should do all the “heavy lifting” on scheduling medications. As such, it meant we needed to pivot and adjust to our user expectations.

At this point we have released three new versions of Transplant Hero that take into account these specific needs of transplant patients and we continue to listen and to learn.

On the bright side — we are getting overwhelmingly positive feedback from people who love the app and it encourages us to see that we are on the right track!

Just in one month after the launch, Transplant Hero has been selected as a Platinum Award winner of the Best Mobile App Awards, under the category of the “Best Mobile App User Interface”!

Moreover, Transplant Hero has been featured on the prestigious American Society of Transplant Surgeons website as well as many community support group pages.

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