Bi-Smart Rehabilitation App

Healthcare Information Communication Service App - THA Surgery

"We want to support the patient from long-distance to increase dynamic contact points in their 8 weeks of THA surgery rehabilitation, so patients can feel secure."  - Stephan (orthopedic surgeon)

User Story

When a patient get over the shock of having to undergo a Total Hip Replacement surgery, the challenge of living a lifetime with Osteoarthritis begins. The patient has to make sure that they understand and will execute the instructions & exercises correctly, because 80% of recovery chances lands on 8 weeks of rehabilitation right after THA surgery. If not done right, the consequences are that either you can't walk without pain in future, can't play sports forever, or you may need an upcoming 2nd surgery due to dislocation or infection.

However, 40-80% medical information provided by healthcare practitioners is forgotten immediately, almost half of the information that is remembered is incorrect. Patient's are in urgent need of support to handle the constant change of information from practitioners through out 8 weeks of their rehabilitation journey.


Renier de Graaf Hospital - Orthopedic
(MSc Thesis Project, TUDelft)


June 2015 - June 2016


UX Researcher & UX Designer


Illustrator, InVision, Interview Scripts, Context-mapping Booklet prior Interview

Business Briefing

Next to a successful surgery, hospital aim to provide support to improve osteoarthritis patient experience for the complete treatment journey.  There is a gap of understanding, where patient live their life with osteoarthritis outside of hospital’s knowledge range. The result of this design presents a strategy to help patients & THA team to manage the exchange of healthcare information, and to collect emotional & physical data to tailor the treatment plan.


1 UX Researcher/Designer (Me)
1 Orthopedic Surgeon- Client (Hospital)
1 Prosthesis Company Representative
1 UX Design Expert- Project Consultant
1 Ergonomic Expert - Project Consultant

Final Design Demo


Design Process

1. Problem Scenarios

“ How are Total Hip Replacement treatment information communicated, and what can we do to improve it?”

2. Project Scope Overview

3. Result of Literature Review

Design Strategy:

1. Eliciting patient’s expectations in relation to the structure, process, and outcome of their care.
2. Propose a change of patient’s perception or cues of action, by designing routes of communication with information strategies.

Design Strategy:

1. Manage and communicate realistic expectations to the patient.
2. Provide corresponding (written & visual) information support.
3. Address patient’s need of the up-to-date digital trends of patient-medical information relationship.

4. User Research

Participants: In total number of 4 young THA patients (average age of 58) were recruited and participated in the user research. Half male and half female, all in Dutch nationality, across different recovery stages from 3 weeks to 2 years after the surgery.

Young THA patient were targeted and recruited because demographic research shows that the upcoming osteoarthritis treatment will be facing baby-boomer generations in upcoming 5-10 years; thereof, tracing the background and habits of the target group will help to provide guidelines to service solutions responding to their specific needs.


Purpose of sensitizing-booklet: to probe patient to reflect through important incidents of their THA treatment pathways with sufficient time and in patient's own privet space, aim to retrieve impressions that might have been forgotten or unsaid. Patient receives the sensitizing booklet through post mail to their home from 4-7 days before the interview session was held, and should be complete before the interview.

Patient Interviews x 4

The interview took place in patient's homes. (To observe how participants move up/down stairs, and to meet their care taker & family in person.)

Part 1. Go over important highlights in the sensitizing booklet - dive in deeper about positive & negative experiences in their journey.

Part 2. Capture patient's personal background and major concerns through part 1, extend the conversation towards a focus on treatment information communication, aim to understand the gap of needs from the current healthcare services and their ideal scenarios.

Part 3. At the end of interview, patients were asked to conclude their treatment experience in a 1 minute video recording to demonstrate their believes.

2 Observation Sessions & Surgeon Interview

The interview aim to understand the reasons behind a standard service for THA regulation, to sketch a neutral point of view about healthcare services offered from Renier de Graaf hospital, and to avoid biased interpretation of patient's need (Goldstein, Elliott, and Guccione, 2000).

Part 1. The consultation content (during consultation meeting between surgeon and the patient prior the surgery). How decisions of patient's conditions being informed and discussed, compare examples of different individual cases.

Part 2. Confirmation of the standard THA treatment pathway, making sure literature review & observation session result were in-tune with surgeon's knowledge and perspective.

Part 3. What is hospital/surgeon's vision about their THA service offerings in 5-10 years from now?

5. Research Result - User Journey Overview

The result demonstrate how treatment information pathway carried out between patient and different healthcare professionals (GP, orthopedic surgeon, orthopedic nurses, physiotherapist, and pharmacies), under home or care environment. The involvement of patient's loved ones as physical or mental support outside of Renier de Graaf Hospital's knowledge is becoming clear. Through this result, we see emphasis of where the treatment information miscommunication occurs, as well as a list of patient's pain-points and wishes to design for.

6. Design Requirements

  THA Patient    

1. Design an effortless way to help the patient to remember & perform rehabilitation exercises accurately, prevent over-active or over-passive behaviors.

2. To help the patient to know what to expect in the next step of each recovery journey, to be able to receive instant feedbacks when uncertainty occurs.

3. Receive active feedbacks and supports in time from healthcare professionals.

4. Enable patients to maintain an overview of the recovery progress, from the aspect of physical activities, pain medication management, and appointments from different healthcare organizations.

  Orthopedic Surgeon   

1. Effective monitoring of patient's recovery progress, including physical activities, possible infections, possible dislocation of the prosthesis, and wearability (personal habits) of prosthesis use.

2. Effective communication regarding THA related information, to and from both parties between the patient and the orthopedic surgeons.

3. Help the patients to set realistic and beneficial expectations towards the recovery procedure, answering to patients' questions as a mean to achieve this result.

4. A vision of realistic implementation of the final design in the near future, where it will become a boost to surgeon's flow of work instead of disturbance, beneficial to all stakeholders in the Hospital.

  Prosthesis Company   

1. Think ahead of the market, expanding the product portfolio on top of the current prosthesis manufacturing services, explore the potential market in the digitalized era.

2. Provide patient-oriented services, reach to the end-users (the patient) as the next step of business strategy, to build brand awareness.

Detailizing Actual Functions - New Interaction Experience

Be “Manager” of his/her recovery pathway, feeling the power of control over his/her instant conditions.

7. Ideation & Functional Analysis

Images below demonstrate the development process of details from screen to screen in terms of physical & digital interactions between THA patient and actors from healthcare environment. 4 categories of activities was enlisted as result of user study and defined UX requirements:

(1) My treatment plan   (2) My activity snapshots   (3) My medication history   (4) My OA calendar 

8. Service Ecology

What can you do with this App

1. Login with a patient number.
2. Rehabilitation exercise reminder and animation demonstration.
3. View your activity diary to monitor the progress overview.
4. Add snapshot of moments with photos or videos to remember.
5. Ask direct questions to the THA team at any time & place.
6. Receive instant support & feedbacks from surgeon at times of alert.
7. Request medicines according to personalized level of pain.

MEMS Registering

9. Information Architecture

10. Wireframing Sketches

11. Service Touchpoints x 7

1. 1st Orthopedic consultation session in the Hospital
Assign a patient number
Give consent to make use of services
2. Day of Surgery
Install micro-chip into patient's hip
during THA surgery
Walk through & assist the patient to start using BiSmart App in the Hospital while resting in bed
Rent a Tablet device to patient for 8 weeks
(covered by insurance)
Start the 1st day of use!!
3. Physiotherapist consultation session
(A) Physiotherapist assign exercises to the patient every 3-7 days
(B) Drag & drop updated exercise videos & instructions to patient's tablet
(C) Video demonstration of the exercise on spot if needed
(D) Prepare & review patient's recovery plan assigned by surgeon
(E) Anticipating patient's upcoming progress & personal wishes
(F) Making accurate judgement with real-time bio-data
4. Personalized rehabilitation activity diary
Patient monitoring with MEMS
(A) Auto-record physical activities (For example 7:00AM - 22:00PM)
(B) Monitoring change of physical status to prevent dislocation / infection
Save significant moment of recovery in the activity diary
(A) Snap-shot moments of the day
(B) Turn on & off the MEMS recording anytime
5. Real-time feedback from THA team
Surgeon sent personal advice when see sight of threat
Review patient's activity diary overview before each consultation session
6. One window for ALL communications

(A) Apply for new medicine prescription & home delivery
(B) Arrange appointments with the Hospital
(C) Asking personal questions to the appointed person in his/her THA team

Answer & respond to patient's requests and needs in time with clear message history

7. At the end of 8th week recovery journey

Option 1:
Hospital turn the recording off forever according to patient's request. The disabled micro-chip track & trace function is not revertible to prevent from possible hacking.

Option 2:
(A) Upgrade to the post recovery version to continue the use of service App.
(B) Some functions would be changed, enabled, or disabled after the system upgrade. (For instance, patient would be in long-term contact with physiotherapist hence certain functions would be enabled; at the same time no more digital feedback from the surgeon after the 8th week.)

12. Example of User Scenarios x 3

1. Forgetting rehabilitation exercises
Physiotherapist switch exercises every 3 days, I forgot my exercises from time to time...
Frustrated about my bad memory, afraid to do the exercises wrong, it might cause harm to my hips...
BiSmart present up-to-date video of the exercises, I can review it any time and any where!
BiSmart do the job for me, I do not even have to remember exercises!
2. Instant feedback from THA team
I do activities that I believe I should do, but sometimes it turn out to be a bad idea, I usually knew it too late...
Sometimes I have symptoms such as swollen feet, I don't know what is the cause of it, I do not know how to react to it...
MEMS detect signs of abnormalities. The surgeon can, in-time, sent advice to my activity diary page with notification.
I adjust my behavior according to advice, I feel more confident and secure about my recovery progress.
3. One window for all needs
When I am desperately in need of stronger pain medication, or to ask a question, I have to call one organizations after another to acquire what I need. Help often does not reach me in time due to difficult communications. I suffer from pain, anxiety, and sleepless nights, feeling helpless.
BiSmart allow me to take an active role to manage my requests to/from the THA medical personnel. I can ask questions, request medicines, adjust and propose appointments through one App!
Being able to self-organize my schedules and to interact with my THA medical team relieve me in time of my struggles. I feel comfort and have a sense of control.

13. Result of Design Evaluation

4 interaction designers participated in one-on-one product-service evaluation of my design. Each participant were giving the background and scenarios of THA treatment journey. Participants click-through the design on InVision and speak-out-loud on the point of improvements. 

Before Evaluation   v.s.   After Evaluation

Final Design Interaction Details

14. Business & Social Benefits

Receive significant emotional & physical data to improve treatment quality.

Deliver last mile of service at patient's home from long-distance, allow surgeon to make flexible use of their in-between time.

Make in-house big-data analysis available by knowing how patient is doing at home.
Receive filtered measurements to improve future prosthesis design.

Increase company brand awareness and loyalty.

Improve customer experiences by means of digital services.

Expand product portfolio on top of current prosthesis offering.
Receive extra services with same amount of expenses.

Shorten the waiting time to arrange appointments & medical prescriptions.

Support & motivate therapy compliance.

Given choices on which data is relevant to share, filtered out the activities patient do not wish to share.
Better therapy compliances means better health result and potential cost reduction.

National healthcare big-data analysis, aim to optimize the prevention & prediction of Osteoarthritis progression. (Senior Health + Chronic Disease)

Yearly budget expenditure & healthcare strategy formulation.

What's Next?

Product UX
(A) Arrange usability testing with real patients if giving more time.
(B) UX research & UI design for surgeon's use cases.
(C) Make pixel & icon perfect UI design.
(A) Deep-dive research on infection prediction (with combination of C-reactive protein level, erythrocyte sedimentation rate, staphylococcus aureus, and staphylococcus epidermis).
(B) Biomechanics research with surgeons on positioning of EMES implementation.
(A)  Investment in MEMS + App. software design.
(B) Outspread the digital product on multiple Dutch hospitals. (Repeatable business model)
(A) Define Healthcare Intervention with GDPR regulations.
(B) Improve tech. acceptance for baby-boomer generation with media advertisement & promotions.

" Let BiSmart does the effort
to find tailored real-time treatment plans for you! "