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Case study
2022

Highnote

Highnote app icon lockup
Industry
Healthcare
Highnote helps hospitals reduce turnover by giving busy nurses a better way to help each other on-the-go.
photo of person using Highnote on Apple Watch
Scope of work
Deliverables
The following represents the scope of work we delivered for Highnote with meaningful collaboration alongside the internal team. We’d especially like to thank Amy, Aaron, Taylor, Greg, Andy, Reed, Matt, Jeff, Santiago R. and Santiago V. You are all a delight to work with.
Timeline
Scope of work
Month
1
2
3
4
5
Product Design
Lo-fi
Mid-fi
Hi-fi
Components
Styleguide
Add-ons
Product Management
Brand
Tagline
Website
Company Deck
Month
Product Design
Add-ons
1
Lo-fi
Product Management
2
Mid-fi
Brand
3
Hi-fi
Tagline
4
Components
Website
5
Styleguide
Company Deck
EXTENDED Partnership
Month
7
8
9
10
11
Product Design
v1.1
v1.2
v1.3
v1.4
v1.5+
Add-ons
App Store Launch
Play Store Launch
User Analytics
Growth Metrics
Sales Engineering
Month
Product Design
Add-ons
7
v1.1
App Store Launch
8
v1.2
Play Store Launch
9
v1.3
User Analytics
10
v1.4
Growth Metrics
11
v1.5+
Sales Engineering
*Month 6 & 12 reserved for strategic planning
Product design Financing
Research
Highnote was born following Amy Papermaster’s PhD research yielding insights about the benefits and limitations of ‘curbsides’ which are informal consultations between healthcare professionals. Reliable access to experienced colleagues is the greatest barrier to curbsides, which are associated with better practice culture and many other positive outcomes.
Through her time in patient care, Amy recognized first hand the need for increased access and availability of experts for curbsides. She saw an opportunity for a technology-based solution to enable clinicians to track their questions and provide just-in-time access to high-quality evidence in the context of patient care decision making.
With Highnote, Amy and her team set out to build the right solution and bring it to the millions of professionals who care for patients every day. Hospitals nursing and learning leadership resonates with the value Highnote can bring to their transition-to-practice programs, especially in reducing turnover, which is commonly at or above 20% (3x what it should be).
Problem
The problem Highnote set out to solve is ambitious: Fix all the unanswered questions between healthcare professionals. It’s a real problem all nurses, doctors, and specialists deal with every day.
When we unpacked it further, we saw how far the problem spread. The people who might know what to do may be busy or too far away. Those who need to know don’t want to interrupt or feel embarrassed asking, so they hesitate.
Not asking the question results in lower-quality patient care, increased frustration, and more mistakes—resulting in 20% nurse turnover in the hospital when it should be 5%. This is a big problem worth solving.
Strategy
Value Map
A graphic of the Highnote value delivery mapA graphic of the Highnote value delivery map
Highnote helps hospitals significantly increase new nurse retention by giving them a new way to help each other on-the-go. Early indicators are in: Nurse residency programs using Highnote are retaining almost all the new nurses. Fewer frustrations and mistakes made all the difference. With help from Highnote, 99% of questions now get answered.
Problem
Solution
New nurses can now ask  for help from any location without hesitation or interruption. Anyone on Highnote can answer when the time is right in a format that fits the moment. If they can’t, they can escalate it to someone who can help.
photo of a doctor using a smart phone
Business-model drivers
Strategy
Increase
Distribution
Platforms
  • iOS
  • Android
  • Apple Watch
  • iMobile
Workspaces
  • Health systems
  • Hospitals
  • Clinics
User Profiles
  • Multiple roles
  • Multiple jobs
  • Job transfers
  • Contact sync
  • Invitations
Increase
Acquisition
User Interface
  • Lo-fi
  • Mid-fi
End-Users
  • Roles
  • Specialties
  • Groups
  • Colleagues
  • Classmates
  • Contacts
Content
  • Questions
  • Answers
  • Insights
AI
  • Extraction
  • Transcription
Increase
Retention
User Interface
  • Hi-fi
  • Animation
Media Formats
  • Video
  • Audio
  • Text
Notifications
  • Questions
  • Answers
Engagement
  • Reactions
  • Follow-on questions
  • Conversations
Discovery
  • Intros
  • Combined Q&A
Prevent
Churn
Feedback
  • Topic tags
  • Switch formats
  • Anonymity (text)
  • Search
Internal Tools
  • User analytics
  • Business metrics
Start
Identity + Tagline
Positioning
We started with a solid foundation with the name “Highnote” and Highnote.com which the founders chose because they believe if more clinicians raise their voice, more clinical problems can end on a Highnote. We developed an iconic mark to build the idea of connection into the brand as well as a simple, 3-word tagline to communicate the brand promise.
Style Guide
Component Library
Design System
Once the brand identity was developed, we turned the graphical elements into components. Next, we created a comprehensive design system with patterns that would make the app feel cohesive while maintaining flexibility for scale and context-specific navigation. These foundational design elements are built-out in a component library in Figma, which connects to all instances of every screen, flow, and interaction in the app.
a graphical representation of the Highnote style guide
a photo of the tiles feature
Feature
Tiles
Elements
One of the features that went through many design iterations are what we call tiles. Tiles represent the beginning of a threaded conversation and succinctly convey summary information at-a-glance.
Feature
Stacks
Interactions
The next feature we designed was a way to stitch together multiple participants from a group conversation into one elegant experience. As the conversation unfolds, it shows the recording in the original format chosen by each author: video, audio, or text using medically-trained AI for transcription.
a photo of the stacks feature
Components
Stack Elements
A graphic of stack elementsA graphic of stack elements
Design
Wireframes
Development
Next, we developed low-fidelity wireframes to form opinions, iterate quickly, test hypotheses, and make changes without being over-committed to finessing high-fidelity designs.
We prioritize design functionality before design finesse so we validate what’s working and what’s not most quickly. Real user testing and data-driven iterations can happen as soon as a v0.1 low-fidelity interface is built.
A graphic to represent wireframes
Design
Hi-fi
Contextual Navigation
Once we had functional lo-fi wireframes developed and mid-fi UI/UX was validated with users we elevated our orientation and designed all the high-fidelity designs.
First up was a simple primary navigation that uses beautifully-rich color gradients to give the user context:  'Incoming' messages on the left (for responding), 'Outgoing' on the right (for originating) and 'Discover' in the center (for searching and browsing conversations). Purple represents combined content from pink and blue.
A graphic of the Highnote app's contextual navigation
a 3 up image of high fidelity screens from the Highnote app
A graphic to represent Highnote's in-app media controls
Feature
Media Controls
Experience
Since Highnote is all about connection, we designed media controls to be visibly connected to the person talking so it feels like you are experiencing a person, not controlling content.
A stack of screens showing Highnote's different media formats: video, audio, text
Feature
Media formats
Flexible Formats
One of Highnote’s many hypotheses we validated early with data was communication on-the-go needed to be in the format that was best for the sender and recipient. Users could choose to author in video, audio or text and respond in kind or change to the format that best fit their circumstances.
Image of Highnote user flows
Process
User Journey
User Flows
We created user stories to understand how a user successfully completes specific tasks in the app. This process documents the paths a user takes screen by screen to ensure the experience is intuitive and clear.
Image of Highnote user flows
Process
Product Management
Roadmap
Every feature in the Highnote app has a purpose and maps to business model drivers: distribution, acquisition, retention, or churn. Knowing this relationship helped form a hypothesis about each feature’s expected value. This mapping made prioritization more objective, less subjective.
We recommended shrinking features down to the smallest possible size to ship sooner and learn faster. Instead of one monolithic product roadmap, we built individual feature roadmaps to keep things organized and create a clear path forward.
Results
App Metrics
Metrics
Format metrics
54% of questions are video, 17% are audio, and 29% are text. For answers, 78% are video, 19% are audio, and 3% are text. Response rate metrics: Of all responses, 33% happen in less than 2 hours, 72% happen same day, and 92% happen next day.
Takeaways
"Defaults are powerful." remarked Taylor Gilbert, PM at Highnote. Many users switched formats to author. Just as many users switched formats to respond. Video or audio format choice was mostly driven by personal preference and circumstances, like being in an elevator. Users ask anonymous questions in text. Almost no users respond in text, possibly due to answer length. Highnote uses AI to transcribe video and audio to text to power search and make it fast to skim. Most answers are 2x longer than questions. So, we doubled the recording length which required refactoring our compression due to bandwidth constraints in hospitals.
View
APP METRICS
If you’d like to see Highnote data from the first hospital customer point of view, take a look at the app metrics.
The graphic for Highnote download button
A graphic representing the app metrics
The tools used for making prototypes
Product
Animated Prototype
Prototype
Now that lo-fi, mid-fi, and hi-fi were complete, we moved the Highnote app to interaction design with fully-animated prototypes of the intended user experience. These are valuable visual specs for the development team and reusable assets for marketing the Highnote app to end users, partners, and investors.
PROduct Marketing
Website
Website
Once animated prototypes were ready, we designed and built a responsive website with scroll-based animations and subtle variations for desktop and mobile at Highnote.com. Big bold headlines elevate the brand experience emotionally while supporting copy makes a rational case for the call-to-action.
Apple App Store and Google Play store logos
Distribution
App Store / Play Store
Mobile
After the website was complete, we designed screens for the App Store for the iOS app and Play Store for the Android app. All of the product marketing materials are component driven, maintaining a connection to the foundational library, so if and when design changes are made to any underlying element, the update propagates though all screens, flows, and app screen shots, so they can be easily exported and uploaded to an app store without re-work. The screens below show mid-fi designs that were shipped to users while hi-fi is in development.
Product screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App StoreProduct screen for Apple App Store
A graphic of Highnote workspaces feature
Feature
Workspaces
Product-led Distribution
Soon after launching the Highnote v1.0 mobile app for iPhone and Android, Highnote gained traction with multiple hospitals in Austin, helping them to reduce new nurse turnover by giving them an easy way to get help on-the-go. We designed workspaces to navigate the organizational hierarchies in healthcare on-the fly so the app would be useful to groups within in a network of hospitals or across neighborhood clinics. Simply tap the drop-down and toggle to the desired level.
Highnote workspace dropdown menus
DISTRIBUTION
Website
Pricing
Since the paying customer is distinct from the end-user, Highnote developed tiered pricing with volume-based discounts at scale. Highnote's pricing strategy starts with the value Highnote delivers for healthcare professionals, then hospital networks, organizations, and custom plans for health systems and clinics. We made the benefits clear so prospective buyers could easily compare and choose.
Image of the pricing page on the Highnote website
A graphic of a venn diagram
Present
Future
Highnote’s long-term vision: help beginners learn from experts and help experts mentor the next generation–starting with nursing in healthcare.
Results
Feedback
Customers
Clearly we believe in Highnote and it shows. But don’t just take our word for it. Hear from the healthcare professionals who use it, and the hospitals that get it.
Baptist Health logo
Knowledge in our field is exploding. Our patients are sicker than ever. We have babies [nurses] teaching babies [nurses].
Chief Learning Officer
Baptist Health
St Davids logo
Highnote improved my learning experience.
Registered Nurse Resident
St. David's
St Davids logo
Highnote helped me gain new knowledge.
Registered Nurse Resident
St. David's
HCA logo
We’re drowning…what we’re doing isn’t working. So Highnote matters.
Director of Professional Practice
HCA
St Davids logo
Highnote is something I’d recommend.
Registered Nurse Resident
St. David's
St Davids logo
It helped me apply learnings to clinical practice.
Registered Nurse Resident
St. David's
Baptist Health logo
Knowledge in our field is exploding. Our patients are sicker than ever. We have babies [nurses] teaching babies [nurses].
Chief Learning Officer
Baptist Health
St Davids logo
Highnote improved my learning experience.
Registered Nurse Resident
St. David's
St Davids logo
Highnote helped me gain new knowledge.
Registered Nurse Resident
St. David's
HCA logo
We’re drowning…what we’re doing isn’t working. So Highnote matters.
Director of Professional Practice
HCA
St Davids logo
Highnote is something I’d recommend.
Registered Nurse Resident
St. David's
St Davids logo
It helped me apply learnings to clinical practice.
Registered Nurse Resident
St. David's
Fundraising
Website
Investors
We started working on Highnote after their pre-seed round and helped them tell the story at the seed stage. We designed investor inquiries into the Highnote.com website and designed a new company deck to present the investment opportunity to accredited investors.
View
COMPANY Deck
Presentation
If you’d like to see the Highnote story told to a seed-stage investor audience, view the company deck.
Highnote
Leadership
Recommendations
It’s one thing to toot our own horn, but it’s another when you hear the words come directly from the people we work with. Meet CEO Amy Papermaster and COO Aaron Papermaster—power couple and co-founders of Highnote. They are an impressive team, perfectly balancing visionary product leadership and domain expertise in healthcare (Amy) and operational execution of a HealthTech startup (Aaron).
A portrait of Amy Papermaster
Amy Papermaster
CEO, Founder
Highnote
Erik and Josh bring ideas to life with a thoughtful balance of delight and purpose. They are both exceptionally talented.
A portrait of Aaron Papermaster
Aaron Papermaster
COO, Co-Founder
Highnote
Erik and Josh have been force multipliers for Highnote, designing the first version of our mobile app that led to foundational distribution deals with top-tier health systems.
A screenshot from the Highnote appA screenshot from the Highnote appA screenshot from the Highnote appA screenshot from the Highnote appA screenshot from the Highnote app
Partnership
App DESIGN
Partnership
We invested 50% of our revenue into Highnote’s pre-seed round. This helped Highnote be capital efficient, manage cash flow, and extend their runway to get product-led growth. Our team delivered everything shown in this case study. Together, we shipped Highnote for iPhone and Android. Within 4 months of launching, Highnote secured 2 of the largest health systems in America as paying customers. Highnote is expanding rapidly with a full pipeline of hospitals ready to join.
PRODUCT DESIGN Financing
Standard
Deal
Terms
50% financing, 2% down, and 48% balance paid over 10 months. Scope of work extended for ongoing feature design work.
Get Quote
PRODUCT DESIGN Timeline
A graphic of the timeline for the Highnote project
*Month 6 & 12 reserved for strategic planning
order summary icon
ORDER SUMMARY
Design
Base
Development
+60%
Management
+40%
Prototype
+30%
Animation
+15%
Illustration
+15%
Website
+30%
Presentation
+15%
Naming
Free
Tagline
Free
Identity
Free
order total icon
ORDER TOTal
$504,000
50% financed
$252,000
2% downpayment
$10,080
48% balance
$241,920
financed icon
Financed
$252,000
Our 50% investment in your company is based on the cash value of our deferred revenue. The instrument for the transaction can be a Note or SAFE that converts into your next equity financing round.
downpayment icon
Downpayment
$10,080
Your 2% downpayment is paid by card or bank transfer to lock in your start date.
balance icon
Balance
$241,920
Your remaining 48% cash balance is paid over 10 months. Please send the following amount on the 1st of each month via wire or ACH.
10 Monthly Payments
$24,192