For a second consecutive year, Applause analyzed testing data across health and wellness companies, assessing the most common flaws in digital experiences across mobile and desktop apps and connected devices – in real-world scenarios – all around the globe. We evaluated thousands of combinations of networks, browsers, payment instruments and integrations for health and wellness customers worldwide to share the most comprehensive view possible of what organizations encounter in their pursuit of digital excellence.
We summarized key points from our State of Digital Quality 2023 report in our recent blog, Improving Digital Quality in 2023: Where to Focus. That report examines broad digital quality trends. This blog post explores digital issues in the health and wellness sector. Our industry report, State of Digital Quality 2023 in Health and Wellness, gives extensive details not covered in this blog.
In this blog, we dig into the following digital quality recommendations and insights:
Cater healthcare experiences to the patient or subscriber
Digital healthcare products and services aim to serve many consumer needs, delivering everything from telehealth visits and patient lab records to sleep scores and body composition analysis. The fragmentation of this space speaks to the robust demand from health-conscious consumers. McKinsey estimates that consumers spend $450 billion on the wellness products and services market, and that it will grow at more than 5% annually. Healthcare and wellness services have evolved significantly over the last few decades — and continue to evolve. No longer do patients attend a yearly doctor visit and make slight changes to their livelihoods; personal wellbeing is an ongoing commitment, one in which consumers will happily invest time, money and attention.
The healthcare services industry, traditionally slow to adapt to change, has been spurred in recent years by circumstances both societal (pandemic) and technological (AI). There is more investment in digital care options as a means of onboarding and retaining a more choice-conscious populace of patients. On the flip side, consumer wellness brands might leverage any digital tools and services at their disposal to enable an insightful consumer product and gain an edge on the competition, not unlike other digital-first brands in industries. Two-thirds of American adults (63.4%) have used a mobile health app, according to Insider Intelligence, and the majority of those users (6 in 10) interact with those apps daily, a remarkable rate of usage compared to other industries. Consumers implement these digital products as part of their lifestyles — as long as they meet expectations.
Every competitor in each health and wellness sector faces its own challenges in delivering the same common goal: exceptional experiences for customers that enables better health and personal care. That means the hardware, software and services must all converge seamlessly for the consumer, and also integrate with other services and products as traditional and connected wellness paths progressively merge in a more connected medical ecosystem — doctors interpreting care options based on at-home wellness device data, and consumers adapting their personal lifestyles and technologies to fit those clinician recommendations. Frustration mounts when defects occur or performance lags, especially when customers perceive these issues as inhibitors to care. In that vein, wellness providers should see digital experiences as extensions of healthcare itself, the same way a doctor’s ability to communicate clearly and empathetically enables better patient care.
Our assessment of the health and wellness sector focuses primarily on two types of companies: patient-facing healthcare services providers, such as hospital care, physician or clinical services and pharmaceuticals, and digital wellness brands, who create products for consumers to optimize their own wellbeing, including fitness or sleep trackers, subscription-based food services and mindfulness apps.
Applause evaluated healthcare and wellness experiences across more than 9,000 bugs, 2,400 individual mobile devices, 275 unique desktops, 270 OS versions and thousands of device/OS/browser combinations to assess endless combinations of networks, browsers, payment instruments and integrations worldwide. Testing included websites, apps, connected devices, mobile web and mobile apps in real-world scenarios.
Enable the digital wellness journey
Down the snow-covered hill, up the stadium steps, over the hurdles, under the tag of the second baseman, and across the finish line — the digital wellness journey is anything but uniform. Crafting a high-quality digital wellness product means catering to any number of individual fitness, dietary and medical goals. These products must also work in their various connected device ecosystems, on public and private Wi-Fi, on a plethora of mobile devices, in varying physical and weather conditions, and with other apps or systems. Digital wellness products that encumber customer journeys are not likely to fit into their lifestyles.
Customer journey testing puts quality in focus wherever the customer travels, digitally or physically. From activating the product out of the box to using it in real-world settings, testing the digital wellness journey with real customers gives brands unique insights they can’t gather during development. Even though you have a state-of-the-art connected device or clinical facility, digital-facing apps are often the entry point for customers — many companies don’t prioritize these interactions enough. Testing the digital wellness journey means supporting customers throughout their lifecycle of interactions with your brand.
To understand and evaluate all the interactions customers have with a wellness brand or products — or that a patient experiences when moving through the various physical and digital touchpoints involved in scheduling and attending an appointment — takes specialized skills and resources. Commit to the task with heuristic reviews and UX research with real customers to understand the end-to-end customer journeys in the markets you serve and deficiencies arise.
Once you grasp the wellness journey, you can pull data and insights from those user pathways. The health and wellness industry increasingly relies on customer data to feed machine learning models, which can deliver everything from patient triage and care suggestions to other wellness or subscription recommendations. Know the journey, and you know the customer.
Be surgical with your functional testing
When it comes to digital quality, it’s one step at a time. While functional testing can — and should — occur throughout the software development lifecycle, healthcare companies and wellness brands must be careful not to fall into a common trap we see every day: the assumption that the digital experience works just fine.
The healthcare and wellness customer is not a single person on a single device. That person is part of an entire household ecosystem. In 2022, U.S. households averaged 22 connected devices according to Deloitte’s 2022 Connectivity and Mobile Trends Survey. Wellness devices and apps must work properly on the customer’s primary mobile device and OS, of which there are thousands of potential combinations — a number that grows every year. Where applicable, these experiences must also enable cross-platform functionality, such as a smart scale being able to input results not only to its native app, but also to a popular fitness tracker app. Defects in these experiences quickly cause patients to call an already overburdened support line or customers to return otherwise functioning products to the store.
Functional testing must be the first line of defense against these outcomes. And as both healthcare providers and wellness brands both venture into AI for customer-facing customer support and data analysis/predictions, there will be an ever-present technical and moral need to ensure products deliver enhanced and accurate experiences. For example, failures in an AI-based chatbot/online booking system to effectively schedule appointments cause frustrations with the patient, who might not get the care they need, and lost revenue for the provider.
Content defects more than doubled over last year (4.6%). With more healthcare investment going toward patient triage and chatbots compared to telehealth a year ago, patients might be experiencing more text communication challenges. The reduction in telehealth appointments could also explain the decrease (25.2% to 19.9% in visual bugs).
All bug types aside from content remained stable or decreased. However, workflow defects still accounted for 57.8% of issues, showing there’s plenty of need to validate web and mobile app functionality.
Case study: Healthcare platform puts patients first
Gruppo San Donato, Italy’s leading private hospital group with 19 hospitals and nearly 16,000 employees across Northern Italy, turned to Applause for a blend of functional, automation and security testing. The provider launched its own mobile and desktop platform to help patients manage their healthcare needs, from finding doctors to booking appointments to managing medical fees and reimbursements. This launch required extra attention to both securing patient data and delivering exceptional patient experiences.
Applause built a solution for the healthcare provider, providing them with 171 testers, who uncovered 374 approved defects across 416 unique device/OS combinations. Testing cycles included managing appointments on different devices, receiving reimbursements appropriate to the country’s healthcare system, and testing various account settings. Through its engagement and ongoing work with Applause, the Gruppo San Donato product team releases with confidence, on-time and every time, delivering reliable digital experiences for its patients.
Localize wellness products to connect with the customer base
Who doesn’t want to be fit and healthy? Well, it turns out there’s no one way to achieve that goal.
Consider the lifestyle of a health-conscious person in a Nordic country compared to an American citizen. Nordic citizens are more likely to prioritize outdoor activities and exercise, work out more frequently, incorporate more whole foods and fewer processed foods into their diets, and have subtle cultural differences in their approaches to sleep, mental health, work-life balance, embracing the cold and even wearing pants.
Localizing a product to a health-conscious Scandinavian consumer is a vastly different task than it is with an American audience. These differences extend all over the world, across regional and international boundaries. Even if you have a revolutionary wellness brand — or, perhaps, especially if you have a revolutionary brand — it takes a great deal of localization research, testing, persistence and empathy to succeed in a new market. Entrepreneurs will always push for more features, more customers and more revenue, but wellness brands must carefully operate in new markets, making sure to account for local preferences and sensitivities — anything less can have devastating consequences for the brand. Patience with localization testing pays off in the market.
Healthcare and wellness companies must create hardware and software that work intuitively in the markets where they do business. Does the product use the right units of measurement? Does it work on popular in-market devices? Does it properly and naturally translate? Does it account for localized diseases or illnesses, or differences in eye, hair or skin color specific to the region? Localization testing helps uncover challenges in these areas reflected by the defects in our report.
Being inclusive for all of your customers means understanding who they are, without even interacting with your product. Only then can you serve up an exceptional localized experience that becomes part of their wellness routines.
Blend care and empathy with accessibility testing
As healthcare becomes more technologically enabled, healthcare companies must adapt to digital accessibility standards — a moving target over time. The cost of turning a cold shoulder to the needs of people with disabilities, not to mention the government regulations and legal litigations that operate on their behalf, such as WCAG 2.2, outweighs the long-term investment required to enable accessible experiences.
For healthcare providers, accessibility is a moral imperative that delivers better care in our digital age. In the height of the pandemic, the majority of patient-physician interactions occurred across digital channels. While telehealth visits are on the decline, there are many people with disabilities that continue to rely on digital experiences as part of remote on in-person care — and these accessible features benefit all patients. Providing accessible healthcare experiences is simply a must, whether to stabilize digital care as a revenue channel or to simply do right by the patients that need it.
Wellness brands will encounter their own unique challenges with usability. Poorly designed hardware and software can be unusable for folks who rely on accessibility features. A great deal of effort and resources go into the design and functionality of a wellness product, but without representation from the accessibility community throughout product development, organizations run the risk of encountering some of the bugs we detail in our report. And with apps available for download from customers that might not even purchase your device, the exposure to litigation is heightened to a global scale.
Brands that incorporate feedback from people with disabilities also have the opportunity to delight demographics otherwise missed during planning and development. For example, how might a blind person’s sleep patterns differ? How can you lead a deaf person through guided meditation? In what ways can a fitness tracker cater to a person with mobility challenges? These are market segments lost when accessibility takes a back seat.
Screen reader defects continue to make up the vast majority of all accessibility errors, down just slightly, by 1.3%, from last year. Many issues can cause screen reader defects, including unstructured HTML code, improperly used headings and poorly coded links. Yet these devices are critical for people with disabilities to access sites and apps.
Color contrast defects increased more than 5% from last year (8.6%). As interfaces change to provide more functionality, users will continue to run into defects, particularly with the contrast between text and backgrounds, unless these experiences are validated.
All other bug type distributions remained consistent, fluctuating less than 2% +/- from last year. We added a new bug type, animation, in which moving content cannot be seen by the user, but these defects were rare.
Case study: Prioritizing usability for everybody
With more than hundreds of care sites across 21 U.S. states, Dignity Health operates under the belief that all people deserve medical care, regardless of background, ethnicity or circumstance. The organization embraces an innovative approach to technology, enabling it to provide mobile apps that assist with patient care and wellness.
In addition to leveraging functional and usability testing, Dignity Health partnered with Applause to build a digital quality solution to ensure accessible experiences for people with disabilities. Applause’s deep domain expertise in accessibility and a diverse base of digital experts helped the company to build and launch better digital experiences with concrete results: a 64% percent rise in website visits, 470% increase in online scheduling and 24% boost in patient satisfaction score.
Secure revenue across all payment channels
Companies all around the world in various verticals are finding themselves in an unfamiliar situation: They are subscription management companies. This is true of the wellness space as well. To keep the customer onboard, the company must eliminate as much friction as possible from the equation.
Take the example of a subscription fitness company. This company might offer a promotional rate, automatic renewal, referral codes and free trials, all of which must work. Payment testing helps brands navigate the oft-complex web of payment flows that can result in the issues detailed in our report. For example, a small oversight might cause debit cards to automatically decline for a subscription service, which can have massive consequences. And try as you might to validate transactions in a lab environment, there’s simply no way to replicate the payment flow than with real, live, in-market payment instruments.
The need for real payment instruments creates a bind for healthcare and wellness brands, who must uncover any payment friction or failures as soon as possible to keep customers happy. Connected device manufacturers that sell directly to customers can’t afford to have unreliable revenue streams, while app developers risk customers abandoning or outright canceling if there’s friction in the payment experience.
The challenge is nuanced for healthcare providers, who typically handle payments after the day of care. Beyond point-in-time payments like co-pays or prescriptions, providers typically invoice and process payments later, after billing a patient’s insurance company for their portion of the bill. Still, when switching to new payment processing systems or receiving an update from your existing provider, payment testing can be a helpful way to identify friction points early in the process to save frustration later.
Digital quality recommendations
Nuance, ingenuity, commitment and empathy ultimately fuel effective digital quality efforts. With a blend of the approaches above, healthcare and wellness companies can ensure higher quality experiences for the customers they serve — not to mention better return on investment for product development.
In the pursuit of this outcome, we offer five digital quality recommendations for companies in healthcare and wellness industries:
Obey the Hippocratic Oath. Physicians take and adhere to this traditional oath of ethics as it pertains to patient care. As patient wellness becomes increasingly blended with digital experiences, healthcare and wellness brands must put this oath at the forefront of their digital transformation and quality strategies. The potential ethical dangers of AI when approached haphazardly are especially problematic when it comes to hampering patient care. A lack of accessible services and experiences can also cause distress and inhibit care for people with disabilities. When a digital screen is the first — and, in some cases, primary — means of receiving care and improving wellness, the patient’s (or customer’s) experience is indeed a vital element of their care, and companies in this space must treat it that way, prioritizing usability, clarity and empathy on an ongoing basis.
Effective AI for patient care. AI is wildly changing the competitive and product development landscape. For healthcare and wellness companies, AI unlocks a wealth of opportunities as it applies to the customer experience, including enhanced search capabilities, smarter chatbots, easier appointment scheduling, and more intelligent or customized wellness recommendations. Healthcare providers have been cautious with how much they enable AI in patient-facing systems because of extra exposure to risk, understandably so. But, given the remarkable progression of these systems, it’s a matter of time before AI takes a firmer hand in guiding patients in their wellness journeys — and expect that wellness device and app manufacturers will be faster to embrace these technologies as a market differentiator. In all of these instances, the experiences and output must match the customer’s expectations. It doesn’t take an artificially intelligent mind to guess what that customer will do if these systems fail or introduce friction.
Know your patient/customer. How do you manage, secure and analyze the data you collect about your customers? And how do you ensure that AI and other systems accurately interpret that data to help customers improve upon their healthy lifestyles? It starts with sophisticated data collection and governance processes, but ultimately must incorporate feedback from users in the real world. UX studies and heuristic reviews can reveal where customers struggle to work with your product or how they interpret app recommendations. Additionally, brands should work to deliver properly localized and customized products that show they are represented and understood. For example, make sure the app translates to the specific Spanish verbiage of a particular South American region, and ensure a fitness tracker app accurately accounts for customers with a heart condition. True user feedback helps achieve these goals.
Make sure it really works. Many healthcare and wellness companies are so eager to get products in the hands of users — either to gather feedback or collect revenue — that they rush them to market before they’re ready. This is a mistake. Cross-platform functionality, user feedback and optimized experiences are all important, but if the app performs poorly, crashes on certain devices or has display issues, those finer details don’t matter. Take advantage of a comprehensive approach to functional testing, blending manual and functional, internal testing and crowdtesting throughout the lifecycle to cover the app from all perspectives. Digital quality is a shared responsibility, and it takes upfront investment and ongoing commitment to deliver high-quality experiences.
Revenue generation is a prescription for wellness success. Payment testing secures revenue streams — it’s that simple. Between credit cards, debit cards, gift cards, digital wallets, automated clearing houses for bank transfers, peer-to-peer platforms, secure remote commerce platforms, and platforms for traditional and decentralized payments, there’s no shortage of ways a customer can pay. Combine that with the complexities of the ecommerce payment process, transactions flowing through as many as six stops on the way to the merchant, and there’s simply a lot of places for the chain to break. Conduct payment testing with real payment instruments and real transactions to eliminate the guesswork, identify points of friction, and make sure the dollars flow as expected.
Index and data references
Use this blog and related report to better understand the gaps in your organization’s capabilities and processes. From there, map out a plan to improve digital quality, regardless of your company’s current state.
For a complete view of the healthcare and wellness industry’s state of digital quality data, visit this year’s State of Digital Quality 2023 in Health and Wellness. It contains details on the following key areas:
Bug type definitions
Bug breakdown charts
Charts illustrating browser and OS combinations (desktop) and device and OS combination (mobile & tablets) and more
Readers can also access our digital quality frameworks, which outline core capabilities and typical processes for organizations at different stages on the journey to excellence. To access concrete guidance on how organizations can improve quality and efficiency, read the State of Digital Quality 2023 summary report.