Hitoe Project Report

2018
members
Cisca Devereux
Vincenzo Morelli
Giulia Negri
Matthijs van Reeuwijk
Marta Zuliani

school
A. A. 2018/2019
Design management lab
Politecnico di Milano

II
 p. 02 00. ABSTRACT

p. 03 01. SENSING NEW MEANINGS

Competitive analysis of the industry
Trends analysis
Steep
Swot
Infobesity

02. ENVISIONING NEW MEANING

Envisioning
Scenario map
Preliminary solution
Interpreters

03. REINTERPRETING NEW MEANINGS

The interpreters
Interviews
Reinterpretation

04. PROBING NEW MEANINGS

Positioning
Personas
Customer journey
Pre-Experience
Experience
Post-Experience
Storyboard
How it works

III
.executive summary
What is the meaning of data in healthcare? What’s hidden
behind a heartbeat? And why is it important to understand
the connection between mind and body?
With the Hitoe shirt technology of NTT Data we designed
a therapy service in the field of mental health based on the
gathering of objective data and a deeper understanding of the
patient status for the doctor. The therapy service enhances
the doctor-patient relationship, provides daily guidance to
the patient and develops an active participatory approach in
treatment.
Globally, mental disorders are commonly arising and com-
plex to treat. In mental health there is the opportunity to
use data technology to innovate treatments and get a fee-
dback on how the therapy is received. Our therapy solution
personalizes the treatment to the patient in a way which
guarantees a higher reliability in taking care of the mental
disease. For the doctor, the system will visualize the patient
data objectively and in a comprehensive way, to overcome the
asymmetric information with the patient and to lower the
doctor’s workload. The Hitoe therapy system will be distribu-
ted through clinics, which will have the opportunity to offer
an innovative therapy.
We developed a detailed example of the patient app inter-
faces on the base of a real therapy case study and defined
a roadmap including the future steps of our Hitoe therapy
V
service implementation strategy. The roadmap includes a
first phase of development of the digital interfaces and of
marketing campaign. Next, a pilot service will be tested in
collaboration with clinics. When the improved service will be
ready for sale to the clinics, a medical cloud will be developed
for the medical community to trigger a learning process and
deeper research from shared data about therapy cases.
The design process described above is part of the course De-
sign Management Lab in the faculty of Management Engi-
neering at the University Politecnico di Milano. The purpose
of this course is to develop a design approach for the data
collecting Hitoe shirt of the company NTT data.
.framing
opportunities exploration
to write
In this stage, we started from the Hitoe shirt technology and
tried to open our minds toward all the possible fields that
were still unexplored by this kind of technology.

With the mind map we broadened the potential contexts

that NTT data could influence; Work, Health, Perception,
Transportation and Domotics. In the second layer, we dee-
pened these directions, and thirdly we described the drivers
with five questions: where, when, why, what and who.

After clustering the thoughts, we decided that Health was

the most promising direction as it gives Hitoe the potential
to provide significant and authentic value to people in need.
Within the Health area lies an extensive and emerging mar-
ket that is open to technological innovation. Secondarily, we
were interested in the relationship between emotions and
technology, and in an application of that in the health field.

VI
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VII
 In this section we investigated a deeper research focused on
understanding the relationship between emotions, technology
and people. We developed our research analysis on three levels;
we started with desk research based on scientific papers, fol-
lowed by interviews to verify and further develop what we di-
scovered. Lastly, through case studies, we identified the state-

.inspiring
of-the-art technology. We then began reframing our problem
to define it in a design direction.

mental condition
the relation among mind body and tech
In this section we investigated a deeper research focused on
understanding the relationship between emotions, technolo-
gy and people. We developed our research analysis on three
levels; we started with desk research based on scientific pa-
pers, followed by interviews to verify and further develop
what we discovered. Lastly, through case studies, we iden-
tified the state-of-the-art technology. We then began refra-
ming our problem to define it in a design direction.
compelling insights
mental health
Mental health is an important part of the overall health and
well-being of a person. It includes the emotional, psycholo-
gical, and social well-being. It affects how a person thinks,
feels, and acts. In other words; how a person is able to control
his/her mood and behaviour in contexts of stress, social inte-
raction, and decision making. Scientists talk about emotional
well-being when people are aware of their thoughts, feelings,
behaviors and are able to recognize their emotions when they
arise. This mental health balance is essential at every stage of
life, from childhood to adolescence and through adulthood.
circadian rhythm
Circadian rhythm can be interpreted as an “internal body
clock” that approximately regulates the 24-hour cycle of hu-
man biological activity.
Patterns of brain wave activity, hormone production, cell re-
generation arise and define the natural inclination of a per-
son to feel sleepy or more energetic with regard to different
moments of the day.
Biological rhythm modification can act as reinforcer of dif-
ferent health injuries or as a specific factor accountable for
modifying biological functions. Routine plays a significant
role in the regulation of a person’s circadian rhythm.
VIII
mind body connection
It has been proven that there are complex interrelationships
between a person’s body and mind. This means that our thou-
ghts, feelings, beliefs, and attitudes can positively or negati-
vely affect our biological functioning. On the one hand, our
minds can affect how healthy our bodies are. On the other
hand, what we do with our physical body (what we eat, how
much we exercise, even our posture) can impact our men-
tal state. Constant high levels of stress hormones and muscle
tension have negative effects for both the mind and the body.
affective computing
AC aims to bridge the gap between human emotions and
computational technology. Current research addresses ma-
chine recognition and modeling of human emotional expres-
sion, including the invention of new software tools to better
manage and understand the ways emotion impacts health,
social interaction, learning, memory, and behavior. use disorders.
In particular, AC measures bio-signals which have proven to causes Globally, mental and substance abuse disorders are very com-
be very strong indicators of our state of mind, such as speech, circumstantial trigger mon: around 1-in-6 people (15-20 percent) have one or more
perspiration, muscle tension, body temperature and heart- experiencing trauma, abusing substances etc mental or substance use disorders. It’s estimated that over
beat. The variety of technological tools people carry in their 1.1 billion people worldwide had a mental or substance use
pocket contains highly sophisticated sensors for detecting disorder in 2016. Among mental disease, anxiety disorder is
movement, speech, facial expressions and voice. most widespread and it is estimated at around 4 percent of
implications the population.
patient accountability physical occurrences North America (21.3% in 2016) and Western Europe (17.71% in
Patients have enormous influence on treatment outcomes. It headaches, mood changes etc 2016) are the geographical areas which present higher rates of
is up to their participation to take medications as directed, mental disease.
follow treatment plans, schedule follow-up appointments, re-
port symptoms honestly and make lifestyle changes. Self-ac- conditions
countability of patients is essential for medical treatment. mental occurrences
The treatment effectiveness is at risk when the patient does depression, panic attack etc
not commit. “Patient shared accountability” is about sharing,
between patient and doctor, the success or failure of treat-
ments. It is a patient-centered approach which requires the disease
patient’s own response into his treatment. It allows patients long term illness
to strengthen their self-confidence thanks to their active par- bipolarism, chronic pain etc
ticipation.

the underlying process problem size

To better understand the problem we wanted to address, we
categorised a process that leads to the development of a se-
rious condition.
It is important to understand that each stage, with repeti-
tion, can provoke a more serious state. Beginning with a trig-
ger caused by a situation or a physical disposition, a person
can inflict physical implications and mental conditions. As
this re-occurs, it leads to long-term problems.
The World Health Organisation tells us that:
1
“Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.”
Mental disease comprises of a range of disorders including
depression, anxiety, bipolar, eating disorders, schizophrenia, 1 https://ourworldindata.org/mental-health#prevalence-of-mental-heal-
intellectual developmental disability, and alcohol and drug th-and-substance-use-disorders

IX
interviews
prevent
Obesity would be a huge pre indicator for a lot of diseases
such as cardiovascular disease, diabetes type 2, they’re all
contributing factors. There’s also a huge link between diet and
cancer and preventative measures can really prevent some
cancers such as oesophageal, stomach, colon... Also lifestyle
habits, such as smoking and drinking can lead to lung cancer.
Accountability is really important, we use accountability a
lot... To see themselves where they can improve is a lot better
because it’s more patient-centred than you dictating and
telling them what to do.
Siobhan
Student in Human
Nutrition and Dietetics
usability
A lot of people, even if they don’t know me, when I am on
the subway or on the way to work, they say “What do you
have? Can you explain to me?” and I think ‘okay, well Google
it, you can look’.
(Libre Link monitoring solution) I use this data often because it’s
very fast. Like before [with the finger prick], even if it took
2 minutes, it’s still 2 minutes. Now it’s like 1 second so I’m
better now because its faster.
Lauriane
22 years old diabetic since she was 11
emotion pattern
From the legal point of view the only way to ascertain a state
of mental illness is by comparison with a specialized doctor.
Even with the opinion of an expert, however, it is not possible
to have absolute certainty because the opinion of the doctor
is subjective and depends on the school of thought adopted.
The triggering causes are mainly of a biological nature,
where the condition is latent in the individual and emerges
after significant moments or develops with time due to
the insistent repetition of particularly frustrating or high
emotional impact moments.
Alan
Lawyer
keep track
Stress significantly affects my performance with music. I had
to give up the violin because I kept having absentee seizures
while playing because I would get nervous coming up to a
difficult bit. It’s so hard to have control over this.
I kept a diary for a bit but I gave up because it’s hard to
constantly keep track. I also experience most of my seizures
during the night so the diary couldn’t record this at all.
Megan
21 year old female with Epilepsy
X
awareness
I felt lonely for a long time. Nobody understood what was
happening to me because I didn’t understand it either. I didn’t
get if the problem was me, or the people surrounding me, or
the world around me. Sometimes I felt awesome, therefore my
family couldn’t understand why suddenly I didn’t want to get
up from bed anymore. This ended up making me feel extreme
guilty and uselessness. When my illness was diagnosed, I
realised it was not my fault, and now I am regaining control
of my life and personal relationships.
Emilia
27 years old bipolar female
support
To be in charge of a bipolar person is like a roller coaster ride.
I moved back and forth from anger, denial, panic and pain
to hope and joy. I gave up many aspects of my life, and my
marriage was also put at risk. Later on, my daughter said she
was very happy that the family remained united throughout.
Today my daughter is stable and independent, she is going
on. It was hard work but rewarding.
Giovanna
Emila’s mother
looking around
technological trends
Feel
A wearable which gathers and elaborates user’s data and
accompanies the user into a guided coaching process. The
user becomes more aware of his emotions and gains a deeper
understanding of the internal and external aspects that
impact his wellbeing.
Somnox
Interactive sleeping robot who supports people with sleeping
problems to fall asleep and keep them asleep. By analyzing
breathing patterns, the robot suggests to play music or a
breathing sound to allow the user relax.
XI
Nest
A set of domotic devices which gather different types of
data from the environment. Nest learns from this data and
improves the comfort of the home system.
market analysis
We analysed the market trends in the healthcare industry,
closely related to and presented in NTT’s Roadmap for the
Triple Aim, to see the potential of NTT in this field.
Three main performance dimensions are described; therapy
outcomes, patient experience, cost.
It states that these performance goals require a constant
communication between doctors and patients as well as an
ongoing interaction between primary care and the wider
healthcare system. For these aims to occur, a modern,
flexible technology that can personalize patient experiences
and reach them at all time is required.
For example, the communication between doctors and
patients can be enabled by a portal for both doctor and
patient, on which the doctor can input patient data, remotely
monitor them and provide him accurate and relevant outputs.
The patient, on the other side, can use the platform to test
results and medical records.
Researches show that 85% of physicians believe that electronic
reminders and health coaching improve patient compliance
and outcomes and reduce staff time spent delivering routine
messages.
Moreover, to enable a wider interaction within the healthcare
system, it’s shown that the use of social media and CRM
systems can enhance patient understanding of disease and
treatment, provide non-clinical patient information to the
entire care team, and allow researchers to increase scientific
knowledge.
Researches show that 80% of internet users have searched for
a health-related topic online, the 63% of these have searched
for a specific disease or a medical problem and the 47% for
medical treatment or procedure.
reframing
drawing boundaries
the problem
Mental health is highly significant in how a person lives,
enjoys and takes action in their life. It can be described as the
‘key to happiness’ and when it is faltering there are powerful
implications on the quality of daily life.
There is a low awareness among society about the causes and
effects of mental health conditions. This has led to mental
health care being severely undervalued personally, medical-
ly, in the workplace, and in relationships. There is a burde-
ning stigma regarding these issues that exist personally and
in society. People facing these problems are often ashamed
of sharing and admitting to emotional distress. This can be
reinforced by cultural barriers and gender roles.
The treatment of mental health is often complex, ineffective
and not straightforward. There is a demand for modern, te-
chnological solutions that match those offered for physical
diseases. There is a lack of evidence- and data-driven cures.
XII
Current therapy is limited by subjectivity, by what the pa-
tient decides to reveal and from the way the doctor interprets
what’s said.
the approach
We will focus on an intervention - targeting the stage before
a series of occurrences become a long-term illness.
We want to support people with a real-time, discreet and
portable tech solutions, in non-invasive manner during daily
life. We want patients to have a participatory approach in
their tre
atment and a strong self-awareness of their problems. We
want to have an impact on society’s perception of mental he-
alth conditions.
people involved
We realised mental disease not only impacts patients’ life but
also people around them. Family and close friends can play a
relevant role in the therapy, therefore they will be taken into
account into the next solution development.
A group of specialist doctors are necessary to contribute with
their expertise and experience.
the metaphor
‘Wear Hitoe and take back control of your life.’
When a person puts on their Hitoe suit, we want them to
feel protected, powerful and confident about the technology,
and about the doctors and research behind it. We want these
emotions to increase, step by step, just like it happens to a
character at the start of a comic book movie who doesn’t re-
alise their abilities, and who slowly realises they has become
a superhero.
metaphor: Armchair metaphor: Superhero armor
XIII
 in terms of cost and time, and effective in terms of reliability
and results. Health organisations, pharmaceutical companies
and medical insurance companies have in common their in-

l
en tiona
terest in the data created by Hitoe, for their different busi-

s
nesses. Respectively, the first wants to improve the quality

titie
uca
.visioning
of their research, the second wants to create new effective

gr ppo al
ed

c
ou rt
su edi
drugs and the latter wants to increase the reliability of the

ps
m
statistical analysis. tio
n
i l iza s
ib rm
ns fo

our scenario
Moreover, we moved our attention toward the user of our se plat
service, the patient, and the people around them.
ort
The patient is a person affected by a mental health condition, ort su
pp
pp
bundaries su

ners
pati paig
ent cam
In this section we carried out a profound analysis of the ele-
ments that comprise the environment of the problem. This rs
tne
consists of the needs and behaviours of the actors, and the relative par medical
s
way they interact with each other. user specialists &
researchers
friends &
a big family collegues service
tech
supplie
Who are the main actors of our service, what do they do, and rs
what do they want?
man

er
In answering to these questions, we started to identify our uf
sup acture

om
potential customers, that are actors to which we are going plie
rs
r

st
cu
to sell something valuable: clinics, doctors, health organisa- r
c to
tions, pharmaceutical and medical insurance companies. do
Clinics are institutes that aim at providing high quality ser-

cs

ion
ini
vices to theirs’ patients and attractive working conditions to

ani h
cl

org healt
sat
theirs’ doctors. Doctors use the Hitoe package for work pur-
poses. They want to provide an innovative therapy, efficient

XIV
whether they are fully aware of it or not. They need to know
that their illness is recognized and there are treatment that,
if rightly accomplished, can improve their situation. They
rely on what doctors say and on innovative medical devices
records. In addition, they are often ashamed to show their
condition. Therefore, they need a discreet therapy shaped on
their lifestyle and continuous guidance during it.
Parents, colleagues and friends are people who know the pa-
tient very well and are emotionally involved with his feelings
and behaviors. Therefore, they are motivated to help the pa-
tient before and during the therapy.
We also identified who are the other fundamental actors to
further develop the service. Medical specialists and resear-
chers could help us to understand how to analyze and use the
data gathered by Hitoe, as well as to build the service conten-
ts. Manufacturer suppliers are useful to the production of er-
gonomic wearables to increase the products offer, according
to the routine of the patient. Then, for the supply of the more
technological aspects of the service, we could rely on exter-
nal specialized tech companies. Finally, since mental diseases
are often undervalued, educational entities, medical support
groups, sensibilization platforms and municipalities play a
fundamental social role in spreading the new medical know-
ledge and in shifting the attention of people toward specific
topics, increasing their interest.
emphatise
We referred to the following role based personas to see the
main needs and frustration of the main user, the patient Cla-
ra and customer, the psychologist Jason.
Clara
the patient, 42 yo
bio
She studied art and today works as professor at University of
Brera. She combines her family with work, and recently was
diagnosed with Bipolar disease by her doctor.
needs
To be independent, able to take care of her family.
At the same time, be guided through her illness’ difficulties.
Spending time with her husband and cultivating her hobbies
frustrations
She finds it hard to understand her situation and communi-
cate it to his friends and family;
Sometimes she feels lonely.
XV
Jason
psychologist, 38 yo
bio
Single man, in love with his work on which he spends most of
his time. When he does not work he trains to keep his body
in shape or cuddles his beloved cat. He has many hobbies but
little time to dedicate to them.
needs
Stay updated by attending conferences and meetings.
Keep close contact with patients.
Limit pharmaceutical therapy if not strictly necessary.
Deepen each case to find the best therapeutic path.
frustrations
The type of work does not allow him to have enough free time
for himself and to develop his private sphere.
Each patient is different so he spends a lot of time analyzing
individual cases and creating hypotheses for the best therapy.
Not all patients react in the right way, this leads to ineffective
therapies and job dissatisfaction.
 once upon a time...
Awareness
stages
Recognise
psychosomatic condition
actors criticalities feelings
confusion
Most of the times close
friends and family members
are those who spot the con-
dition, while the patient is
not aware about his illness.
hitoe opportunities
Thanks to its continuous
monitoring, Hitoe could
automatically recognize the
conditions and support the
patient to ascertain the su-
spicious condition.
Access/Buy
Get info about the illness
and search for clinic and
specialised doctor
frustration
Finding the right therapist
with uncertainty about the
disease itself can be compli-
cated and lead to a long rese-
arch process.
The adaptability of Hitoe to
the disease can represent a
guarantee instrument for the
adequacy of the therapy, in-
dependently from the clinic
and the specialist
Use
Plan the adeguate
therapy for the
individual case
uncertainty
Often for the doctor him-
self it is difficult to plan a
therapy, with this type of
disease the personality of
the patient makes each case
unique and difficult to treat.
The planning phase of the-
rapy can achieve adequacy
because of the highly perso-
nalization on the patient.
XVI
Follow the treatment
(medicines & psychiatric
sessions) and monitor
the improvement
unconfidence
Complex and multi-aspect treat-
ment to follow. Patient is not in-
dependent, when is alone, he is in
danger and can’t be controlled.
Hitoe could support the process
in terms of: facilitate interaction
between doctor, family, patient
and daily support to the patient
critical moments.
After Use
Recover and try to solve
episodes and possible
repercussions
fear
With this type of disease the re-
lapses are frequent and difficult to
control, it remains uncertainty of a
definitive healing.
In a second moment, Hitoe can
support the patient in case of
need, providing greater auto-
nomy and a guarantee of support.
a new story

Clara is feeling frustrated, stressed and her men- Jason is excited to receive the innovative Hitoe Clara seeks medical help and visits Jason’s practi- Clara is wearing her Hitoe Clothes during a cri-
tal health is in despair. Jason is a new doctor that package and to learn about its many benefits for ce. He offers the Hitoe Therapy as a solution to tical situation. The device recognises her eleva-
is competing with older, established doctors. his practise. her mental health disorder. ted emotions and instructs her on how to relieve
the situation.

Jason is delighted with his ability to remotely Clara feels though as she has a suit of armour At the end of the therapy, Clara returns the Hi- Clara has returned to full health and is living a
monitor his patient and see her growth and pro- protecting her throughout the day! toe Package. Jason prescribes recommendations balanced life. Jason has attracted many new cu-
gress via the Hitoe Interface. on how to continue based on the data gathered stomers due to his accurate and effective therapy
throughout the therapy. on offer!

XVII
 Patient Relatives

.developing
hitoe therapy service Hitoe Patient
Kit
Hitoe Patient
App
Hitoe Relatives
App

to write
In this last section we present in more detail the Hitoe the-
rapy service, including a qualitative description of the servi-
ce, the business model, a first draft of the XXX prototype and Hitoe smart Hitoe smart Patient emotion
Real time Challenges Achievements Medical Emergency Patient emo
a plan for future implementation steps. clothes accessories emotional status diary tips intervention diary

service description
Hitoe offers a unique and revolutionary system for both pa-
tients and doctors that transforms traditional and outdated
therapy to the modern technological era based on objective
patient data.
The patient benefits from a Hitoe Patient kit. The kit consi-
sts of a set of wearables which are adapted to different daily
activities. This is worn continuously by the patient to gather
objective medical data on physical parameters. The items are
selected based on the requirements of the patient. The custo-
mization of the therapy is set by the doctor, in close contact
with the patient.
The patient is supported by the Hitoe App on a daily basis
to retrieve advice and guidance in both everyday and critical
situations. The app features real time emotional status and
challenges, which are driven by an innovative AI support sy-
stem. Challenges are prescribed to teach the patient healthy
habits and guide them to recovery. They are rewarded with
positive achievements to track their progress. The app inter-
venes when a critical scenario arises, recognised through the
data from the wearable, and responds in a effective way by
communicating with the patient and instructing how to re-
lieve the situation. The patient also has access to customized
medical information and routine management provided by
the expertise of the doctor. The patient can also get involved
in community activities and forums.
Patient activity is stored in a virtual diary that is comprised

XVIII
 Relatives Doctor

Hitoe Relatives Hitoe Doctor Hitoe Medical

App Interface Community

edical Emergency Patient emotion Therapy data Routine Patient Overtime Patient emergency Patient Patient data Publications
tips intervention diary and feedbacks management profile medical data communication cases warehouse and blogs

of app activity and personal feedback from the patient. The
diary allows the patient to check their behaviour regarding
past and present activities.
The service provides an app also for a small selected group
of family or close friends who take responsibility for the pa-
tient’s wellbeing. The main function of this app is to connect
the patient with an emergency contact in a critical situation.
In addition it allows this group to have access to reliable in-
formation about the patient’s condition, in order to increa-
se their awareness and be capable to respond in a conscious
manner to the patient’s behaviour.
The doctor is presented with the Hitoe Doctor Interface in
which the personal patient parameters can be set and the pa-
tients interpreted data is visualized in a comprehensive way.
The app provides efficient access to the patient’s emotional
diary and direct feedback from the progress of the patient’s
therapy. The doctor can use the interface to personalize the
therapy instructions presented to the patient by having a de-
eper understanding of the patient’s status.
The doctor is also connected to a team of specialists which
enables a dialogue to improve patient data warehousing and
research publications. A digital extension for the medical
community is the medical cloud, which doctors and resear-
chers can consult the Hitoe medical data.

XIX
 Patient
In the system map it is shown that the patient app collects
the data from the wearables, the external apps and sensors on
the patient’s phone. This data is combined and processed by
the AI system, which interacts with the patient app and to
the doctor interface.
Phone Hitoe Patient Hitoe Patient
Sensors App Kit
AI will provide personalized daily guidance and suggested
activities on the basis of the patient’s status to the patient
app. Secondly, AI will provide a comprehensive overview
about the patient condition to the doctor.
Community
Hitoe Medical Doctor Researcher

Relatives Hitoe AI Hitoe Doctor Clinics

App system Interface Data about patients will be anonymously collected in a cloud
Hitoe main offert
shared among the medical community to create a therapy
overview and learning for the doctor.
Hitoe main offert The anonymous data in the doctor interface can later on be
shared encrypted with the medical community for improve-
Hitoe Medical
Interface Community
system App ment of the therapy.
Hitoe Patient Hitoe Doctor Hitoe AI Relatives
Kit
Clinics
For a simplified cash flow, the Hitoe Therapy is paid by the
patient to the clinic together with the usual treatment pay-
Docto

ment. The clinic in agreement with the doctor will buy the
financial flow therapy according to the revenue model which will be descri-
data flow bed in the Business Model Canvas section.
Doctor Researcher
XX
Clinics
Kit App Sensors
Hitoe Doctor Hitoe Patient Phone
mvp
a real case
The Minimum Viable Product (MVP) we present to the pu-
blic consists in a flow of interfaces of the Hitoe patient app,
aimed at describing the main elements of the user interaction
with the service.
To develop a first realistic solution that shows how the ser-
vice does effectively support the patient, we based the fol-
lowing examples on a real therapy case.
We analyzed in collaboration with a psychologist, our patient
Clara with her habits, routine, and the particularities of her
disease; bipolarism.
The characteristics of the bipolar disease that will be presen-
ted are limited to the basic information necessary to better
understand the service solution, nevertheless, a deeper analy-
sis was carried-on to define the details of the solution.
Do you remember Clara? passions
She loves going to art exhibitions with her husband and tell
bio him every single hidden detail;
She studied art and today works as professor at University of she often practices outdoor activity such as running.
Brera. She combines her family with work, and recently was
diagnosed with Bipolar disease by her doctor.
needs
To be independent, able to take care of her family.
At the same time, be guided through her illness’ difficulties.
Spending time with her husband and cultivating her hobbies
frustrations
She finds it hard to understand her situation and communi-
cate it to his friends and family;
Sometimes she feels lonely.
XXI
therapy goal and setting case evaluation: bipolar disorder hard to manage. As a matter of fact, Clara often finds herself
Bipolar disorder causes a periodic cycling of emotional sta- with memory blackouts and confusion. For example, Clara
tes between manic and depressive phases. Manic phases con- loves running in the park, but it frequently happened that she
tain periods of extreme activity and heightened emotions, could not recognize where she was...this scared her so much
whereas depressive phases are characterized by lethargy and that she started avoiding outside activities!
sadness. The patient is usually not aware of when a state is After this analysis the doctor will help Clara to set a goal
occurring, while relatives and friends are those who spot the to reach before the next appointment. They will choose tho-
abnormal behaviour. se activity that Clara should try to accomplish in the first
Mania phases occur suddenly and effect the physical status time period in order to organize a first basic routine. This
of the patient. In most of the cases, cognitive behavioural will start from necessary activities, such as hygiene and heal-
therapy is applied. This therapy has the aim of first, guiding thy nutrition and to some more effort-related ones. Clara was
the patient and making him aware of his altered emotional a full professor at Brera Art university. From now, she will
Case status, and second supporting the patient in meditation and work part-time and dedicate some free time to therapy-rela-
evaluation relaxation. ted leisure activities.
Depression instead, impacts on the patient’s mind. The pa-
tient will tend to think negatively about themself and them- kit composition
self abilities, and will be lead to segregation and laziness, to Clara will select a set of wearables suitable for her routine.
finally be unable of conducting any activity. In this situation The available wearables differ in the attributes displayed in
routine analysis the app will mainly help the patient to focus on fundamental the radar diagram, and therefore adapt to different activities,
goal setting
values of life and on beautiful aspects of the patient’s life, and such as sport, work and free time.
to enhance his personal qualities. Support from family and
friends is essential, therefore patients will be counseled on patient app setting
the behaviour they should conduct. Now that Clara’s new routine and goal are set, it is necessary
to set the app accordingly. The challenges of next period will
Kit composition routine analysis and goal setting be set on those activities as it will more deeply explained in
The first step of the therapy consists in defining, in doctor’s next section. Also the interface of the whole app will be de-
room, the therapy goals of the patient and the setting of the fined on the basis of Clara’s interest. In this case, since Clara
patient’s app. The challenges are set to allow the achievement loves art so much, paintings and artists will be the theme of
of these goals. her app!
Patient app In particular, the routine is analysed in the patient’s per-
setting spective. Clara identifies all those activities which she finds

XXII
 Sport app stucture
Sizable

Wearing time Comfortable

Seasonal Convenient

Discreet
Home

Work Challenges
Sizable

Wearing time Comfortable

Achievement
Seasonal Convenient

Discreet

Emotion diary

Free time
Sizable
Medical tips
Wearing time Comfortable

Seasonal Convenient

XXIII
home
Here Clara’s real-time emotional status is visualized through
a painting in the background. It is selected by the AI on the
base of a weighted average of the different parameters’ va-
lue gathered by Hitoe. The painting is an intuitive expedient
aimd at making the interface as more delicate and commu-
nicative as possible. The type of subject rapresented in the
image is set on the basis of the patients’ passions. The app
warmly welcomes Clara when she access the app.Also the
doctor has access to the visualization of real-time status of
the patient.
challenges achievement
The challenges are a set of tasks that Clara has to accompli- This interface shows the progress of the therapy by recording
sh to proceed along the therapy path. To make this path as the results achieved challenge by challenge. The app displays
simple and effective as possible, an accurate definition of the which kind of challenges between passion, physical, social
challenges is fundamental. For this reason during the setting and mental are pursued more often by Clara. It shows the are-
phase, the doctor will be in charge of building the challenges as on which Clara should focus more and those where she is
according to the defined new routine of Clara her passions. already performing well. The AI can detect patterns on how
This interface will show the completion level of the current the achievements contribute to the patient well being and
goal and will invite Clara to address different types of chal- display this to the doctor and in the emotions diary.
lenges. When a challenge is completed, the feedback from the
patient, the time of completion and physical data gathered
during the challenge are collected by the app into the emo-
tion diary section.

GS 9:41 M 58 %

hitoe
hitoe GS 9:41 AM 58 % GS 9:41 AM 58 %

hitoe hitoe
GS 9:41 AM 58 %

hitoe
GS 9:41 AM 58 %
Current challenge
GS 9:41 AM 58 %

Express yourself hitoe Therapy Challenges Task Therapy Challenges Task

7 days left
Express yourself Therapy level 
The more levels you unlock the bigger improvement 
Therapy Challenges Task
Tasks completed
A balance of ac vi es will help you to improve faster!
Individual challenge
you’ll see
All Individual Group 2/7 completed Challenges completed
Look at all you’ve achieved so far This Week This Month
Individual challenge 7 days le
There are moments during day where 
Individual challenges expressing yourself will be par cularly 
difficult.  
Challenge yourself by training your body and mind A series of exercises will help you gain more  Social Physical Sweet dreams Level 3
confidence and better communicate your  To improve sleep quality  
emo ons. 10
and relaxa on 
7 1 Week
We can do it! Level 2
To collaborate and understand   6
What you need
Level 3
each other as a team 

Let’s move Precious time Passion Mental The pleasant rest Level 2

3 Week 2 Week Re‑discovering your talents and ambi ons
To allocate  me for yourself and   9

Hi Clara,
15 12 You start to explore what you’re good at and  
what you want to do to take a deserved break
Don’t forget  
about me!
7/28 The art of naviga on

how are you?

Level 1
To familiarise yourself with   7
Group challenges See all your results
how the therapy will go 
Challenge each other by working together

Level achieved
Level 2
Best friend The banquet 15/15
The art of being comfortable with oneself
1 Month 2 Week You start to learn who are you and how to feel  
20 5 at ease with yourself

Level 1 7/7
What is happening?

XXIV You start to prac ce exercises that will teach  

and guide you through the therapy  
diary
The diary is the part where the system keeps track of Clara’s
records, provided both by the AI’s analysis of data/challenges
patterns and by Clara herself.
The diary collects Clara’s feedback just by asking her que-
stions during the day or right after a challenge, through visual
or voice notifications. In this way keeping the diary becomes
easy and not a tiring activity.
These feedbacks will be used by the AI to self-learn with the
aim to improve the next challenges selection.
medical tips
The medical tips consist of information about the patient and
doctor, as the therapy path, appointments, prescribed medi-
cines and information of when to take them. An extra feature
is the nutrition advice which can be created by a nutrient
specialist part of the medical community. The AI system can
sent notification to remind the patients about appointments
and medicines to take.
emergency intervention
When the parameters collected by the Hitoe shirt exceed a
set threshold value, the phone will push a notification and the
patient will be forced to choose to either make an emergency
call or leverage Hitoe support steps. In this critical situation
of mania or depression the Hitoe support assigns small tasks,
such as breathing, walking or calling close family member to
help Clara reach a more balanced state. If there is no response
from the patient in a limited time, the app will automatically
make the emergency call to the person indicated in the set-
ting phase.

hitoe hitoe hitoe

hitoe hitoe TO decide TO decide
DIARY
MEDICAL TIPS
Week Month

DIARY Your doctor

your emergency contant are your emergency contant are

stability

Medicine

Profile Feedback

Daily routine
Therapy & info
Walk outside (20 min) T
T Emergency call Hitoe support Emergency call Hitoe support
10 min call with Mum
M W T F S
Nutrition
from medical community
5 min meditation

XXV
business model

KEY PARTNERS
Health Care provider
Clinics: Humanitas
Research centres:
ASP - Association Italian
Phsychologists
Software, data analysis & AI
NTT
KEY ACTIVITIES
Collaboration with Clinics
Therapy def. and improvement
Data Infrastructure management
AI infrastructure development
Patient/Doctor Platform
development & maintenance
Mktg & Adv (target, engage, sell)
KEY RESOURCES
Human: Doctor, Data Analysts,
Software/App developers,
AI Analysts, Mktg & Sales
Techology: Hitoe patent
Physical: Hitoe Patient kit
Hardware data structure
VALUE PROPOSITION CUSTOMER RELATIONSHIPS CUSTOMER SEGMENTS
Reduction of bias in Awareness/Evaluation → Doctors’ in private Clinics
doctor-patient communication “Hitoe Therapy” congress, (GP, psychologist, psychiatric, nurse)
Reliable & Interpreted Data provide the Specialist magazines
Additional information from Pilot Independent Doctors
doctor with more reliable information
about the patient condition; project involvement
Purchase →
More effective and efficient therapy pro-
Physical Channel
cess
Online Channel
Effectiveness: customized and accurate
therapy through patient active partici- After sales →
pation Hitoe direct assistance office
Efficiency: AI support makes the data
analysis comprehensive and highly infor-
mative for the doctor;
CUSTOMER RELATIONSHIPS
Cloud share of medical data
Reliable interpreted medical data; for Co-Creation and Collaboration
medical case consult, comparing treat- Online Community
ments, research;

COST STREAMS REVENUE STREAMS

Mktg & Sales HW & SW development Doctors’ Training Hitoe Therapy licence
Wearable devices production Data management Hitoe kit “pay per use”
Human Resources
Access to Medical Data Cloud

XXVI
revenue streams
Private clinics buy the “Hitoe Therapy” according to a reve-
nue model which comprehends “licensing” and “pay per use”.
The clinic will pay a fixed amount to access the possibility to
offer the therapy to its patients (which will last for a period
of 3 years, once the project is a regime).
In addition, clinics will pay a variable amount which depends
on the volume of patients that will use the therapy at the
clinic (this additional part will be paid at fixed time periods).
partnerships
We analysed the key activities and resources required to im-
plement the “Hitoe therapy” and identified potential part-
ners that would add on NTT resources and competences’ to
create a stronger national market entry strategy. At the same
time, we pointed out why the potential partners for clini-
cs and research would be interested in a collaboration with
NTT.
Clinics: Humanitas
Founded in the mid-80s in Milan, Humanitas is today one of
the most technologically advanced hospitals in Europe. With
the mission “to integrate health-care, research and training
to offer their patients the best care in the world at affordable
prices” Humanitas is also an university teaching center, and
neuroscience is one of their research field. For these reasons,
a partnership with Humanitas will bring NTT not only in
touch with the clinical world of an advanced hospital, but
above all with a community of doctors, researchers, nurses
and health professionals who are constantly work to realize
their mission.
Research: Associazione Italiana Psicologi (ASP)
Since 1978, ASP is a qualified reference point for psycholo-
gists and psychotherapists and also an organisation for all
those who believe in the the prevention and treatment of
mental illness and in the social and individual improvement
of the quality of life. Their values are oriented towards the
development of society and the promotion of health on the
national territory, understood as physical, social and men-
tal well-being. We think that they can be very helpful to the
improvement of our research, as well as the quality of Hitoe
services and their user-friendly languages.
value proposition
From our Hitoe Therapy solution the following benefits are
explained for the patient, doctor and clinics.
Firstly, the patients with mental diseases using Hitoe the-
rapy are able to actively participate in therapy by completing
small physical and mental challenges step by step. In this way
the doctors advice is translated into comprehensive and low
barrier participation that can be performed in a work and
home environment. Sharing the data collected by the shirt
helps them to benefit from a more reliable therapy reducing
the amount of medicines used.
Second, we target the main pain of the doctor: asymmetric
information in the relationship with the patient. There is
a limitation of doctor’s awareness about the precise men-
tal condition due to many possibles reasons such as, lack of
self-awareness, patient resistance etc. Moreover, for a doctor
it is difficult to check the patient’s loyalty to the therapy sug-
gested. For these reasons, the Hitoe therapy, based on data
and not only on verbal communication of symptoms, will al-
low the doctor to reduce the information asymmetries with
their patients. Moreover, the supporting AI system will lower
the workload of the doctor that can check the visualized data
XXVII
of the patient in one glance inside the doctor interface. For
example, before meeting the patient the doctor can quickly
check the development of the medical status of the patient of
the last week in the doctor interface.
Third, the value that we are proposing to the clinics consists
of two elements: an innovative Hitoe therapy and a medical
cloud. The first allows the clinics to reduce treatment time
and cost and improve the quality of the medical treatment
on the personal level of the patient. Secondly, the medical
cloud provides research departments with up-to-date large
scale data and also improves the reliability of the therapy. The
medical cloud is a shared platform that learns about mental
diseases (medical and emotional user data) in combination
with the doctor’s therapy and feedback.
communication plan
Nowadays patients are more and more personally searching
for information on health and disease prevention, and they
use the opportunities of internet to choose their doctor, he-
alth facility or therapy. There are two important elements
which Hitoe should take care of. Firstly, raising awareness
of mental health problems towards potential patients and
doctors. Secondly, make sure the Hitoe therapy is perceived
as a safe and trustworthy solution by the healthcare actors.
Therefore, the communication plan will include a exposure
on social networks, press campaign and medical congresses.
In order to raise social awareness about the seriousness of
mental conditions there will be conducted a campaign on
social networks. For the posts’ content, Hitoe will involve
psychologists, experts and (famous) testimonials that suffe-
red from mental disorders. To increase the effectiveness of
this marketing campaign, Hitoe will outsource it to an ex-
ternal company, such as InClinic, that has been operating for
several years in the field of strategic consulting, communica-
tion and marketing in the healthcare sector.
To target the medical sector, articles on specialist journals
(such as Lancet or Nature) which show the effectiveness of
of Hitoe. At the same time, the participation to healthcare
congresses and medical fairs.
A research shows that in Italy one press release about a rese-
arch article usually results in 139 articles written by the main
news outlets, 128 new tweets with a total followers’ base of
152704 users, 2 new Wikipedia entries and 8 new blog posts.
future roadmap
the first 24 months
In a 24 months timespan we categorized the roadmap in five
layers: marketing, sales of the product, financial investments,
technological development and pilot project phases.
During the first six months, we will develop the patient
app and doctor interface as well as starting a first round of
promotion at medical congresses to present the first deve-
lopments of Hitoe service therapy. Also, it will be started a
press campaign to raise social awareness about mental health
disease.
Afterwards, it will start a first pilot therapy in collaboration
with a few clinics which will test the patient app, the basic
Hitoe shirt and the doctor interface.
After 12 months, the Hitoe therapy will be further improved
and sold to clinics; another round of promotion at medical
congresses to show the refined solution and social media
campaign. raised by 8 percent. Pharmaceutical companies are facing this
The next step will be that of integrating the medical com- increasing demand, investing huge amount of money in rese-
munity in the service; it will be implemented by developing arch and development of new drugs, since in the mental-heal-
a medical cloud for sharing therapy data within a team of th field the knowledge is still undeveloped. Novartis Interna-
experts working in the clinic. tional AG is a Swiss multinational company operating in the
In a further future perspective, building a reliable and up-to- pharmaceutical sector. Its mission is to discover and develop
date medical cloud where medical data are combined with innovative treatments, identifying new ways to make them
patient feedback, doctor therapy learnings and patterns reco- reach as many people as possible.
gnition, the medical cloud will become a high-end source to We think that a combination between the new trends and the
be consulted for research and innovation purpose. mission of Novartis is enough to justify the interest of this
company on Hitoe data.
further future II
Another further future application of the service could be
that of selling the data also to pharmaceutical and insurance
companies. We identified two potential targets coming from
these two sectors.
Insurance: AXA
Although in Italy public health-care is free, it doesn’t work
very efficient so some people prefer to pay for private heal-
th-care to get a better service. Insurance companies, such as
Axa, offer insurance to people to use private health-care in
exchange for an annual premium.
Since we positioned our Hitoe therapy in private hospital
(i.e. Humanitas), we could think to add this therapy in the
AXA insurance package. Since a huge quantity of data is very
valuable for insurance companies, it is easily plausible that
a company like AXA will be interested in this type of part-
nership.
Pharmaceutical: Novartis
According to AIFA (Italian drug agency) studies, in 2018 sa-
les of medicines to fight neuroses, panic attacks and insomnia
XXVIII
Project
Therapy Pilot Community Pilot

Tech

App, Kit, Interface Implementation User kit Community platform Implementation

Finance

Investment 1 Investment 2
Sales

Hitoe therapy
Marketing

Medical Press Medical Social media

congress campaign congress campaign

Now 6 12 18 24
months months months months

XXIX
XXX
.references
00. ABSTRACT

01. SENSING NEW MEANINGS

Peter Laurence McKinnon_Fatigue and stress in long distance road transport_2004y

Claire Doyle_Jane Hutton_Understanding the mind-body link_(year?)
Penny de Byl_A conceptual affective design framework for the use of emotions in computer game design_2015
Nick Goodwin/Natasha Curry/Chris Naylor/Shilpa Ross/Wendy Duldig_Managing people withnlong-term conditions_2010

https://www.mentalhealth.gov/basics/what-is-mental-health
https://meetsomnox.com/
https://nest.com/it/?&43700034535668745&gclid=CjwKCAiA0uLgBRABEiwAecFnk-ExWCv8FWemgKzp1ttMQw7n5wHXCrEV3qmhAYOeh-0WonIejhxVQRoCcx8QAvD_BwE&gclsrc=aw.ds
https://us.nttdata.com/en/-/media/assets/infographics/apps-hcls-delivering-on-the-healthcare-triple-aim-infographic.pdf

[https://ourworldindata.org/mental-health#prevalence-of-mental-health-and-substance-use-disorders]

03. REINTERPRETING NEW MEANINGS

The interpreters
Interviews
Reinterpretation

XXXI
XXXII