The document discusses onboarding users to companion apps for connected medical devices. It emphasizes the need to consider the entire system, including the physical device, packaging, and printed instructions, as well as the digital app experience. An effective onboarding process motivates users, provides prompts to encourage actions, and makes the necessary actions easy to complete. The packaging and printed materials can be used to introduce the app and get users to download it. The app then provides opportunities through its interactivity to further onboard users and encourage long-term engagement with the connected health solution. The overall goal is to design an integrated physical and digital system that makes it as simple as possible for users to understand and start using the new medical technology.

1. Paul Greenhalgh at Team Consulting
Over the past decade, the number
of smartphone users has rocketed to
more than 3.5 billion globally and that
number is forecast to grow by several
hundred million in the next few years
(1). Medical device developers are
turning to smartphones and digital
solutions to help improve usability and
patient adherence. While the potential
for connected solutions is high, how
can we ensure users adopt them?
App Onboarding
App onboarding refers to the act of
introducing a user to a digital solution,
highlighting key information, and
making sure they get set up effectively.
When considering the onboarding
experience of connected medical
devices, it can be helpful to think of the
analogy ‘you can lead a horse to water,
but you can’t make it drink’. In digital
design, the challenge is almost the
reverse of this. There are myriad tools
to keep users engaged once they have
onboarded on a digital solution, from
screen prompts to positive feedback
techniques. However, what do we have
at our disposal to coax them to these
solutions in the first place?
Companion App Onboarding
Onboarding within companion apps
for connected drug delivery devices
is a slightly different situation to
standalone apps. A standalone app
delivers a full service, whereas a
medical device companion app cannot
deliver the drug itself – a device is, of
course, needed for that. Instead, the
app is merely there to enhance the
device experience, to help prompt,
educate, and reassure the user, as
well as record and pass on their data
once they’ve agreed to share it. When
discussing the user experience (UX) or
the user interface (UI) of a companion
app, it’s important to consider more
than just pixels and touchscreens.
The app is one part of a bigger system
design that includes the physical
product, structural packaging, printed
patient information, and educational
material. Developers need to consider
not just how to onboard the user onto
the app, but what might motivate and
guide them to download it in the first
place, connect their device, and sign
up to the full connected experience.
This can be especially challenging
if the device can be used both with
and without connectivity, in which
case the user needs to be convinced
of the benefits of this add-on
feature.To complicate things further,
designers are also working in a highly
regulated industry where there are
firm requirements on elements of the
system. For example, medical devices
Leading the Horse to
Water – A System Design
Approach to Onboarding
Parenteral medical device developers are bringing together design solutions
that can bridge the gap between the device’s inner workings and the end user
Parenteral Technology Supplement
12

2. Parenteral Technology Supplement
require a paper patient information
leaflet (PIL), which communicates
critical information about both the
device and drug, and there are also
tight constraints on what can and
can’t be put on drug packaging and
labelling.
What Does Effective System
Design Include?
It’s important to consider a user’s digital
and physical interactions or touchpoints
in the system design. How can these be
used in combination to the best effect?
The aim is to help the user to unpack,
familiarise, and set up their new device
including downloading the app, signing-
up, and pairing it with the device. So yes,
it’s a little more complex than onboarding
with a standalone app.
For the purpose of this discussion, the
‘system’ will be limited to the physical
objects and digital assets directly
connected with the device. The physical
objects will include the device and
ancillary components, PIL, primary and
secondary drug packaging, and carton.
The digital assets will include the app
and possibly a web portal. Of course,
the system could be much bigger than
this, and almost certainly forms part of a
bigger care solution package.
Picking the Right Tool(s) for the Job
In the case of a connected drug delivery
device, designers will likely need to
address a number of design challenges,
including how to:
•Help users onboard, set up, and pair
their new device
•Showcase key app functionality, such
as dose tracking
•Highlight key information about the
treatment
•Support training of correct use
The different media available to designers
(print, digital, structural packaging,
physical product design) all offer unique
opportunities to guide users through the
various parts of their journey.
What Are the Pros and Cons of Different
Elements in the Patient Onboarding
Product Ecosystem?
•Digital
Pros: Can provide information in an
interactive manner, to zoom and scroll
text, use animation or video, and
progressively introduce information to
improve understanding. External prompts
such as push notifications or pop-ups can
also be used to prompt an action.
Cons: Companion apps will be fighting
for attention with other apps on the same
home screen. The viewable area is also
relatively small, and a user might be
digitally averse.
•Print
Pros: Greater space to provide more
information in a single view than digital,
using folds or page breaks to break
up content. Designers can choose
colour, typography, imagery, paper
stock, and print quality to add ‘value’
to the printed artefact, giving it more
prominence to users.
Cons: Information is static and difficult
to layer. Unlikely to be carried around
constantly like a user would with a
smartphone.
•Structural packaging
Pros: Instructions for use or access to
digital content can be signposted through
carefully placed prompts. The layout of
the pack can encourage behaviours,
such as correct orientation in the hand
or assembly of components in the right
order. A visual reference guide to system
components can also be created to aid
identification in instructions.
Cons: Works best on first opening,
however some users might discard it
without realising.
•
Device industrial design
Pros: Colour, material, and finish can be
used to highlight key touchpoints and
make features more easily referable in
the instructions for use (IFU). Visual
and haptic feedback can also be used
to provide reassurance of correct use,
while form and affordances can ‘nudge’
correct handling and orientation.
Cons: Opportunities may be limited
due to devices’ technical requirements.
Modifications can also be expensive.
Designing for Behaviours
The Fogg Behavioural Model (B=MAP)
states that a behaviour will only happen
when three things occur simultaneously
– a user must be sufficiently motivated,
have the ability to complete the action
required, and be prompted to do so (2).
By focusing on the opportunities, each
component in the ecosystem offers
to add motivation, prompts, and to
facilitate ability, designers can maximise
the chances of encouraging a desired
behaviour. For example, users could
be motivated to download an app by
adding a snapshot of the benefits the
app provides on the carton. Designers
can make it easy for users to download
and pair to their app using a QR code
that opens up the app and provides
fast pairing. To prompt them to do this,
a label on the device, which must be
removed prior to use might be added, or
a flap in the packing that must be lifted
before the device can be accessed.
The Role of Packaging –
Leading the Horse to Water
The device packaging is likely to be
the first physical touchpoint a user will
interact with when receiving a product.
It provides a good opportunity to help
users understand that a companion app
is available to them (prompt), how to
access and download the app (ability),
and how it can improve the management
of their condition (motivation). If the drug
delivery device needs to be connected,
packaging and print can also be used
to start the process of guiding setup,
although this might be easier to do in the
app itself due to the interactive nature of
a digital experience. So, the goal might
be to get the user as quickly as possible
onto the app.
The action of accessing an app has been
greatly improved with the interaction of
fast pairing or app clips, whereby users
can access a cut-down version of an
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3. Parenteral Technology Supplement
Paul Greenhalgh has 20 years’ experience
in the development of medical devices.
Since joining Team Consulting in 2001 he
has worked for some of the largest pharma
companies and most innovative medtech
start-ups, developing groundbreaking
solutions to improve the way healthcare is
delivered. Paul is driven to design products
that provide the level of UX we’ve come to
expect, all the while working within the tight
constraints of a highly regulated industry. He
has a degree in Product Design from Central
St Martins, London, UK.
app so they can experience the benefits
before downloading the full version. This
can be achieved by scanning a QR code
or tapping an NFC/RFID tag, removing the
need for a user to search for the app in
the app store and leading them quickly to
the next round of prompts and motivators.
The Physical/Digital Handoff –
Making the Horse Drink
Once in the app, designers have a lot
more functionality at their disposal.
However, the experience still needs
to be made friction free, allowing the
user to access the features of the app
as simply and easily as possible. Good
digital onboarding often starts with
an onboarding flow; a specific set of
screens or UI elements that are not part
of the regular app interface. Onboarding
flows can be particularly useful for drug
delivery companion apps due to the
following components:
•
The app functionality is likely to be
tailored to the user’s context and goals.
A brief questionnaire may be required
to capture lifestyle information, pre-
existing conditions, or health history
•
Goal setting is widely used as a
behavioural design technique to
promote treatment adherence. Often,
successful onboarding experiences
ask a user to input their goals early
on. This helps the user to feel invested
in the app experience, making them
more likely to return
•
Personal information will typically be
required, and, therefore, users will
be expected to create an account
and confirm their identity to view and
manage their data. It’s worth noting
that in certain cases, developers may
want to encourage a user to start
using the app before they add this
information. Some sign-up processes
can be long and complex, so it can
be helpful for a user to be invested in
the app a little before they’re happy to
enter this information (enter the role of
packaging and print materials)
When a user starts to use an app,
key features and actions should be
highlighted, and complexity avoided.
Sequencing and progressive disclosure
are principles to adopt here. Gradually
introducing users to a digital service in a
way that helps them to feel comfortable
leads to better continued engagement.
However, it shouldn’t be too easy.
It’s beneficial to add an appropriate
challenge, or ask users to complete
a task. It may seem counter-intuitive,
but when a user’s mind is exercised a
little, they’re more likely to return to the
product.
There’s a powerful tool available to
the digital companion app that isn’t
available in printed media, and that’s
the power of others. Social support is
widely understood to be beneficial for
many conditions. In treating chronic
conditions, patients benefit from the
empathy they receive from peers going
through the same experience. These
social spheres are readily accessible via
an app, for example, by sharing your
progress with friends and others.
The Importance of a Concurrent
Design Approach
The importance of considering
packaging, information, and digital
design strategy early in a device
development programme is often
overlooked. A simple feature introduced
into packaging might save a whole
load of expensive modifications to the
device design. Considering IFU or
the app while designing a device may
open opportunities to make referencing
features easier, such as the colour or
shape of a button, i.e., ‘push the blue
button’. Doing this early, before doors
have been closed, due to key project
milestones means that designers can
still address challenges with the most
effective solutions.
The level of human centric challenges
in medical device development requires
designers to use all touchpoints of
a product experience to encourage
correct behaviours. Taking a system
design approach and considering all
elements concurrently maximises the
chance of success – getting the horse
to drink!
References
1. Visit: www.statista.com/
statistics/330695/number-of-
smartphone-users-worldwide
2. Visit: behaviormodel.org
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