Checkpoint and Your Bladder Score

There was something else — my diary summary was an avalanche of data, useful for me (or other doctors), but incomprehensible to the parents. I needed an additional step between the raw diary data (and the super-comprehensive report) and any therapeutic tool I planned to develop. Users should be able to visualize the data they recorded and easily understand how it measures bladder health, or bladder control.

I was considering a simple and understandable design, one that would clearly show the level of bladder control. I was thinking about stars — you know, zero stars, very bad bladder control; on the other hand, three golden stars meaning perfect bladder control. I did write down criteria for how to describe perfect bladder control using stars: for example, reaching expected bladder capacity, having an optimal urination count per day, drinking the right amount of fluid during the day, and not having incontinence. But while writing and reflecting about it, there was one huge problem: such a score was unresponsive to change. It meant that a patient could have one golden star, work to improve their drinking habits, spend a lot of time managing this — and this still wouldn't be sufficient to increase the score to two golden stars. If I was that user, I would get disappointed fast. And that disappointment would push families away from the only thing that actually helps — sticking with the healthy habits long enough to see them work.

So I set out to develop a scoring system ranging from 0 to 100. I called it Your Bladder Score: zero means no control, 100 is the bladder-control champion. Adding five ranks to describe the current score also seemed sound. I started adding categorical variables that, if won, would contribute a different value to the total score. For example, one variable is coded to add 8 points to Your Bladder Score if the analyzed bladder-diary data calculates an Overactivity Index below 23. Eventually I ended with 18 different variables, each with a different weight. I checked how the different variables and their weights behaved in different diary scenarios and eventually had to tweak each one, adjusting the weights so that the whole behaved as a valid bladder-control measurement — reliable and responsive to change. The result was a composite score that described how successfully a patient controls their bladder, based on the bladder-diary data. Then I transformed all the variables into badges and gave them gamified titles and clear descriptions, so families could see what was achieved and where to improve. When we tested this scoring later, it turned out to be too strict and still needed more tweaking to end valid and reliable — more on that when we get to the Coach validation.

To visually represent these badges and improve the overall app design, I talked to Maja, a designer my friend recommended. Maja suggested and drew a mascot. I was initially reluctant, but in the end I am satisfied that she persuaded me to go with the plan. I worried it would look silly and childish — you need to understand that parents approached me as a doctor for help with a serious problem, and I didn't want to trivialize it. Maja was persistent, and argued that families needed something warm to push them through the therapy plan and everything the app has to offer. The mascot she created was a happy blue blob representing a full bladder. The internal name was Pishko — a name you'd call someone who pees often, but in our case the name didn't bother our mascot at all; he was always cheerful, knowing he was in the right hands. Eventually, my wife told me Pishko looked great and that she liked the whole idea, so that settled everything. The path to a happy marriage is to listen to your wife, I suppose.

This part of the application — the one that examined bladder diary data, calculated Your Bladder Score, and showed which badges were won and where to improve — I named Checkpoint. The whole idea and visuals were ready in time for the regional pitch competition. That came out as convenient, since I had something to pitch: first, the problem of incontinence in children, and second, the solution of remote, personalized, 24/7 therapy with Checkpoint. I didn't expect much from this pitch. When I delivered it on stage, I returned to the car and headed home. My three-year-old son was in intensive speech therapy at the time, and I had to take him to the therapist that evening. He had therapy four times a week, because he used only a couple of words to communicate and seemed frustrated about this. For both my wife and myself, our youngest son and his therapy were the priority.

On my way back home, on the intercity road in the middle of nowhere, I got a call from one of the organizers asking if I was still nearby, and if I could return, because the announcement would be of interest to me. I suspected it could be a win. I turned the car around at the next intersection and headed back to the venue. Back on stage was the head of the jury, talking about a promising team that has expertise but recognizes the continuous need to grow. Announcing my team as the winners and getting the prize of 7,000 euros was an overwhelming moment. The fact that my idea was recognized as valuable, and deserved to be awarded, was my moment of gratitude for the positive feedback. I believe each founder comes to a moment when doubt about the usefulness of the project is so great that it threatens to cancel the whole thing. That moment was all I needed to know that I was developing something worthwhile. And, to mention it, I still made it on time to pick up my son for therapy — I skipped the after-party of the ceremony.