A new kind of “therapeutic app” is changing the healthcare landscape, one that patients download to their smartphones after getting a prescription from their doctor. Since the revision of Japan’s Pharmaceutical Affairs Law in 2014, this field has been growing rapidly, with CureApp emerging as a leading developer of such apps. But how do these therapeutic apps differ from standard healthcare apps? And what makes it possible to deliver treatment through an app? We spoke with members from CureApp to learn more about the innovative treatment experiences they aim to provide.

Kei Kobayashi | UX Designer & Psychiatrist, Design Department at CureApp, Inc.

Kei graduated from the Kyoto Prefectural University of Medicine in 2009. After gaining clinical experience as a psychiatrist, he developed a strong interest in the intersection of design and medicine. In 2021, he joined CureApp as a designer, aiming to serve as a bridge between medical practices and design. He is also the author of the book “医療者のスライドデザイン” (2023), which provides guidance to doctors on how to design PowerPoint slides more effectively.

Shoichi Nagata | Head of Design Department, CureApp, Inc.

After starting his career as a designer at the design consulting firm Softdevice, Shoichi worked at Samsung Electronics Japan, where he was involved in UI/UX design and design management for the Galaxy smartphone series. Later, he became a Fulbright Scholar and pursued a master’s degree in design at the Massachusetts Institute of Technology (MIT). While studying at MIT, he helped launch several startups, including developing a VR platform for the elderly. Upon returning to Japan, he co-founded a startup and managed product development for self-care habit-forming services, as well as corporate business launches and operations. He joined CureApp in May 2023.

A New Form of Treatment: Doctors Prescribing Apps

To start off, could you tell us more about “CureApp”? It’s my first time hearing the term “therapeutic app.”

Shoichi: Our vision is to “create a future where treatment is delivered through apps.” We aim to address various social issues in healthcare, such as regional disparities and inconsistencies in the quality of care, by providing technological solutions like therapeutic apps.

Kei: CureApp specifically focuses on the “treatment” aspect within the overall healthcare process. The value we want to provide to end-users includes improving patients’ conditions and meeting the needs of healthcare professionals. Similar to pharmaceuticals, our therapeutic apps are prescribed by doctors and are designed to be effective for conditions such as hypertension, alcohol dependence, cancer, etc.

The content provided varies depending on the condition. For example, our app for hypertension treatment offers educational content about the disease, recommendations for lifestyle changes, and tools to help patients adopt and maintain healthier habits. On the physician’s side, we offer a dashboard to monitor patients’ treatment progress, supporting the establishment of proper lifestyle habits.

How do these therapeutic apps differ from typical healthcare apps?

Kei: Our therapeutic apps receive manufacturing and marketing approval (pharmaceutical approval) from the Ministry of Health, Labour and Welfare, and are covered by insurance. There are multiple stages to obtaining this approval, with clinical trials being one of the key events. We work closely with public institutions like the Ministry of Health, Labour and Welfare and the Pharmaceuticals and Medical Devices Agency (PMDA), collaborating with multiple medical institutions to collect data on the app’s efficacy and safety by testing it on actual patients. The results of these clinical trials are published as research papers, and once they pass review, the app is recognized as an insurable medical device.

At CureApp, we involve experts from various medical fields in the early stages of app development, allowing us to create a unique design that takes into account clinical trials, insurance approval, and practical use in medical institutions after the product is brought to market.

Bridging the Gaps in Evidence Through Understanding Patients

I hear it takes several years to go from the start of app development to insurance approval. It seems quite different from the typical startup approach, which often aims for speedy releases.

Kei: Yes, since we need to release our products as trustworthy medical devices, we must identify and carefully address any factors that could impact safety. Additionally, to establish solid evidence through clinical trials, our development process needs to create something that can be expected to have proven therapeutic effects based on theory. Unlike many startups, our process doesn’t involve releasing a product for users to try out and then improving it based on their feedback. We have to be precise and thorough from the very beginning.

How do you ensure that something will be effective during the development phase?

Kei: Take hypertension as an example- there are already several proposed approaches to treatment, with numerous research papers providing evidence of their effectiveness. We thoroughly study these papers and incorporate their findings into our therapeutic app. Before conducting clinical trials, we test the app internally and conduct user tests on patients while limiting certain clinical aspects. By combining theory with validation, we fine-tune the app as much as possible.

It’s hard to visualize how you translate evidence from papers into an app. What considerations go into this process?

Kei: Evidence from research papers is typically statistical. For hypertension, for instance, a study might compare people who follow a sodium reduction program with those who don’t, and if the blood pressure of those on the program significantly decreases, it’s reported as “sodium reduction may lower blood pressure.” 

However, these are statistical insights and may not directly translate into therapeutic app content. For the app, information that aligns more with the individual’s characteristics and lifestyle is crucial. This means understanding how patients can incorporate behaviors like sodium reduction into their daily lives and what kind of advice or suggestions can encourage such actions- details that often aren’t found in academic papers. A design-based approach is needed to fill in these gaps: understanding a patient’s daily habits, analyzing what makes sodium reduction difficult, and developing optimal solutions to turn these insights into app features.

Shoichi: The evidence doesn’t automatically transform into therapeutic app content, leaving significant gaps to be filled. This is where our design process comes in, aiming to bridge these gaps effectively.

While we ensure the therapeutic effect by the release stage, not everything is completely understood at that point. We continue to analyze post-market data on how patients use the app and what factors enhance therapeutic effectiveness, making improvements as we go.

How do you deepen your understanding of the patients, which serves as the foundation for everything?

Kei: It helps that physicians are directly involved in our development process. The founders, Satake and Suzuki, are practicing doctors, and multiple physicians from different backgrounds, including myself, contribute to development from the initial stages. With our clinical experience, we can identify patient challenges and concerns to some extent. At the same time, approaching patients from a design perspective and conducting interviews often reveals new issues that aren’t immediately apparent in a physician’s daily work.

Bridging Communication Between Doctors and Patients

What kind of challenges have existed in the medical field so far? In what ways do you think therapeutic apps are effective solutions?

Kei: A major issue is that both doctors and patients struggle to consistently maintain necessary lifestyle habits for treatment. While having a doctor offer constant support might improve a patient’s lifestyle, neither the patient desires that level of intense intervention, nor is it practical for a doctor to check in with the patient daily.

In this context, therapeutic apps are an ideal solution for supporting patients’ daily lives. Since smartphones are used every day, they are perfectly positioned to act as a mediator between the doctor and patient, facilitating the appropriate behavior changes.

In fact, even though it was under the unique circumstances of a clinical trial, the usage rate of our hypertension management support app exceeded 98% after 12 weeks of registration. This high figure is largely due to the app being prescribed and used under the guidance of a doctor in a medical setting. Patients start with the understanding that it is “necessary for treatment,” and the regular touchpoints of follow-up appointments every few weeks reinforce the use of the app, which in turn supports fundamental lifestyle changes.

So the fact that it is “prescribed” plays an important role in the patient’s overall experience. Are there any specific strategies to ensure that patients understand it as a “prescribed treatment”?

Shoichi: Yes, we also prioritize communication in our design. A key focus is on how to introduce the therapeutic app to patients, specifically how it is explained in a medical setting. We experiment with ways to make it easier for doctors to present the app, including what materials would support their explanations and what to provide to the patient before and after the prescription. For example, we currently offer a starter book that guides patients on how to begin using the hypertension management support app, helping to reinforce its role as a prescribed treatment.

Kei: When we gather feedback from medical institutions, we find that very few doctors have sufficient time for their consultations. Therefore, introducing something completely new like a therapeutic app, explaining it, obtaining patient consent, and then prescribing it can be a burden. To facilitate this process, we need to design the information delivery in a way that minimizes effort, ensures clarity, and effectively communicates the content.

The key is to prioritize familiarity from a medical perspective over novelty. While we are dedicated to the uniqueness of therapeutic apps, highlighting this aspect too strongly might create a barrier, particularly for older patients who may find the concept unfamiliar. Instead of positioning the app as the centerpiece by saying “Let’s treat you with this app,” we aim to integrate it as a natural part of the overall treatment program, guided by the physician.

Shoichi: Our focus is on “designing the entire treatment experience.” We think about all aspects, not just what the patient does with the therapeutic app, but also how the app fits into the physician’s workflow, what steps they go through, and how they view the data. This holistic approach connects everything into a seamless process.

From Screens for Doctors to Screens for Both Doctors and Patients

What kind of design considerations have gone into the physician-facing app screens? 

Kei: Initially, the physician-facing screen of the hypertension support app was designed for vertical scrolling, allowing access to a wide range of information. However, when we conducted mock consultations within our team to test how effectively the information was being used, we discovered that much of it was being overlooked. As a result, we redesigned the screen to consolidate information into a single view, with tabs for switching between different sets of data. This improved the usability and ensured that important details weren’t missed.

Kei: A key aspect of the consultation process is the ability to compare multiple pieces of information simultaneously. Physicians quickly make comparisons between the patient’s complaints, test results, imaging findings, physical symptoms, and vitals. Therefore, it’s crucial to have related information consolidated on one screen. For instance, if a blood pressure graph is displayed alongside lifestyle information, it becomes easier to hypothesize how certain habits might be affecting the patient’s blood pressure. This ease of comparison aids in the diagnosis and treatment decision-making process.

Shoichi: However, some doctors prefer to print out the screen or show it directly to the patient on the monitor. It’s not just about maximizing efficiency for the doctor; it also needs to be user friendly for the patient. Even something like designing a graph can be challenging. If it has scales on both axes, some patients may struggle to understand it. Striking the right balance between clarity for physicians and accessibility for patients is a challenging task.

That said, we are starting to receive feedback from physicians like, “This graph design isn’t clear for patients.” It’s a sign that even when designing physician-facing screens, there is a growing awareness of the patient’s perspective, which is a very positive development.

Maximizing the Value of the Consultation Room Experience Through Technology

What do you prioritize to ensure doctors and patients can work together effectively in treatment?

Kei: Perceptions of treatment can vary greatly depending on the disease and, of course, from patient to patient. It’s important to communicate clearly why treatment is necessary, helping patients understand the improvement program of the therapeutic app as an option before moving onto medication.

For treatment, we often present patients with two benchmarks: the “medically recommended target” and “the level we expect you to achieve.” Patients then set their own goals, and when they achieve them, the app or physician praises them. This kind of “reward” is also a key element.

However, because our focus is on treatment, we prioritize intrinsic motivation over extrinsic rewards. Instead of using gamification elements like coins or items, we aim to enhance and support the patient’s own motivation toward treatment.

Shoichi: Since the physician plays a role in this process, the reward could be seen as coming from them. Patients are often happier to receive praise from their doctor than to just get positive feedback from the app itself. So, maximizing the experience within the consultation room is crucial.

How has the communication between doctors and patients changed within the consultation room?

Ando (PR): We’ve heard feedback that “the consultation room has become livelier.” It’s no longer just the doctor speaking; patients are talking more as well. The knowledge they gain through the therapeutic app about improving their lifestyle habits helps them better understand the doctor’s advice, leading to more meaningful and informed discussions, which ultimately improves the quality of the consultation.

Shoichi: With CureApp, patients can share diaries with their doctors, which helps highlight areas where they are doing well and those where they might be struggling. These insights have become talking points during consultations. For example, a doctor might say, “You haven’t been able to exercise, but you’ve done a great job reducing sodium intake.” This helps with both assessment and providing appropriate guidance.

While some might think of technology as a standalone solution, it seems like your approach focuses on enhancing the entire treatment experience and maximizing the consultation room interaction.

Kei: We’ve emphasized the importance of the physician’s role, but I believe therapeutic apps serve two major purposes. First, since medicine is fundamentally based on human-to-human communication, treatment apps are tools designed to enhance this interaction. Second, there are challenges in healthcare that are difficult to resolve through human communication alone, and treatment apps help to alleviate this burden.

We haven’t talked much about the second point yet, but an essential benefit of therapeutic apps is making it easier for doctors to do things they previously couldn’t due to time constraints. If the app streamlines processes and cuts down on costs, that’s a huge benefit.

Still, the communication between doctors and patients is always the foundation, and I don’t think that value will change even after 10 years. While AI will undoubtedly bring many changes to the medical field, medicine today remains heavily reliant on human interaction. We believe that therapeutic apps, by facilitating this communication, hold great potential to fundamentally enhance the quality of care.

Aiming for a Future Where Therapeutic Apps Are the Norm

Finally, could you share your thoughts on the possibilities for the future?

Kei: Beyond the consultation room, we’re exploring social networking features to connect patients with one another and doctors with each other. While such tools already exist in society, implementing them as medical devices presents significant challenges due to the many unpredictable factors involved. Nonetheless, we believe that promoting behavior change could be achieved by anonymizing information and allowing patients to compare their data with that of others, rather than relying on direct interactions like chats.

Shoichi: Currently, CureApp’s products are the only therapeutic apps that have received manufacturing and marketing approval and insurance coverage in Japan, but Digital Therapeutics (DTx) is truly an emerging field. Many pharmaceutical and venture companies are actively researching and developing therapeutic apps. We hope this field will grow significantly in the future, offering a diverse range of apps for various conditions and becoming a standard part of treatment.

To achieve this, we aim to create an environment that can provide a variety of digital therapies to patients. The “DTx Design” we’re pursuing is still far from being a fully established system. We will continue to explore what truly matters every day and hope to make steady progress in making therapeutic apps a standard part of healthcare.

Special thanks to:
CureApp, Inc.
Medical Product: “Cureapp”