Home Hemodialysis 2.0

Home Hemodialysis 2.0 is a mobile app prototype designed to enhance the experience of patients dialyzing at home. The ultimate aim is to encourage dialysis patients to choose home dialysis over in-clinic dialysis by dramatically improving the home experience through interactive education, AR-assisted training, and gamified learning.

The application contains interactive games, augmented reality technology, quizzes, and videos to educate patients about machine setup and the needling process. It is given to patients immediately after they are added to the waitlist for home dialysis training, using the waiting period as a pre-training phase that prepares them emotionally and mentally before in-clinic training begins.

Based on patient feedback and stakeholder interviews, the foundational problem was the existing instructional manual, not updated in years, dense with medical terminology, and impossible for a non-medical person to follow. But the manual was only the entry point. User research revealed the real problem space was significantly broader.

What Patients Were Experiencing

• Machine setup tube connections were manageable for experienced patients, but self-needling was consistently cited as the most challenging and anxiety-inducing step.
• Reading the manual while simultaneously connecting the machine was physically and cognitively impossible for most patients, the steps were not easy to remember.
• Troubleshooting guidance in the manual was incomplete: it did not cover all reasons an alarm might sound, leaving patients stranded when something went wrong.
• Cleaning procedures were taught once and rarely reinforced, patients felt uncertain about correct sanitisation steps between sessions.

Direct Patient Voices

"I did not find much difficulty in machine setup tube connections but as a newbie, I experienced difficulties in troubleshooting, needling, and cleaning processes. In particular, the self-needling was challenging." , John Brown, new home hemodialysis patient, St. Joseph's Healthcare Hamilton.

"I do the connections by reading the instructions from the manual. I find it hard to read and connect the machine simultaneously. Since the steps are not easy to remember." , MarieAnne, wife of in-clinic training patient Paul.

Design Thinking methodologies and Human-Centered Design principles were applied throughout. The analogies approach was central, structuring and developing insights from the patients' perspective to ensure the solution was relatable rather than imposing new complexity on an already-stressed population.

Analogies and Ideation

To explore the breadth and depth of the design challenge, analogies were used to ensure the solution was built from patients' existing experiences rather than imposing new mental models. Three analogies shaped the entire design direction.

• Trying a MacBook in an Apple Store, the application gives patients a safe space to experience the dialysis process before their actual training begins.
• Learning by Playing, interactive game levels replace passive manual reading, helping patients learn faster and remember steps more reliably.
• Training Wheels, a pre-training phase during the wait time prepares patients emotionally and mentally before in-clinic training starts.

The Home Hemodialysis 2.0 application addresses the foundational problem, the inadequate instructional manual, by replacing passive reading with active, game-based learning across all five stages of the dialysis process. The app is introduced during the wait time before in-clinic training, giving patients a safe, low-stakes environment to build knowledge and confidence.

• Interactive machine setup game with drag-and-drop tool placement and step-by-step instruction progression.
• AR needling simulation giving patients the felt experience of the needling process before their first real attempt.
• Treatment monitoring module covering sanitisation protocols and the key numbers to watch during dialysis.
• Interactive troubleshooting system replacing an incomplete manual with a tap-to-resolve alarm response flow.
• Cleaning game levels reinforcing correct tool selection and sanitisation procedure through interactive repetition.
• Pre-training phase design using the existing waitlist period, no additional time burden on patients or the healthcare system.

Wireframes were built and tested with patients across the machine setup and AR needling stages. Prototyping and testing confirmed that the interactive format significantly outperformed the manual for learning retention and emotional preparedness.

• The scope of a clinical UX problem is almost always broader than the presenting complaint, what looked like a manual readability problem revealed five distinct failure modes across the entire dialysis process.
• Analogies are a powerful design tool in high-stakes, unfamiliar contexts: grounding the solution in patients' prior experiences made a complex medical workflow feel approachable.
• Designing for emotional safety is as important as designing for task completion in clinical contexts, the AR needling feature succeeded specifically because it addressed fear and anxiety, not just procedural knowledge.
• Stakeholder validation at every stage is non-negotiable in healthcare UX, especially for accuracy-critical steps like needling order and alarm troubleshooting.

Home Hemodialysis 2.0 demonstrates that patient experience in clinical settings is fundamentally an education and trust problem. The instructional manual failed not because patients couldn't read, but because it asked them to learn complex procedures passively, in isolation, without repetition or emotional scaffolding.

The future build should complete all five game levels, develop a fully functional mobile application with AR and VR technology, and deploy it as a standard part of the home dialysis waitlist process. The goal: by the time patients begin in-clinic training, the material feels familiar, not foreign.