Common threads: A perspective on multi-device continuity

How can we create seamless product experiences for a multi-device world? Design for continuity is relatively new in the mobile space, but I’ve been inspired by how other disciplines, especially the health industry, tackle the concept. This piece explores how healthcare’s continuity of care model (informational, relationship and management continuity) might be used to reveal best practices for designing multi-device experiences.

My mother struggled for 8 months with terminal cancer. There were numerous procedures, appointments, and providers involved. Any given week might include treatments from radiation specialists, oncology visits, check-ins with her primary care doctor, pickups from the pharmacy and, near the end, visits from up to 3 different hospice nurses. That was all in addition to family obligations.

Luckily, she had a great care plan. Her oncologist communicated directly with radiology to schedule radiation appointments and always followed up with her. Hospice proactively coordinated with her doctor to order medications, supplies and treatments. No one lost track of her appointments or medications. There seemed to be a continuous relationship between my mother, her long-term care, and her providers, and it improved the quality of her life throughout the illness.

In fact, the healthcare industry has spent many years working on ways to conceptualize, structure, and evaluate this sort of continuity of healthcare. Called continuity of care, it aims to address the growing fragmentation of healthcare as patients make use of increasing provider options. Why does healthcare continuity matter? Several studies have shown that it increases patient and doctor satisfaction, improves the likelihood of patients following up with appointments or prescribed regimes, and can even improve clinical outcomes.

Continuity of care as a lens for multi-device continuity

Here in the product design world, we struggle with our own form of fragmentation. 90% of people consume media using 4 devices (phone, tablet, tv and PC/laptop) in a given day. Multi-device fragmentation is predicted to grow; 1.4 devices per capita, worldwide, are predicted by 2017. A smaller study suggests a current global average at roughly 2.9 mobile devices per person. That number doesn’t even include devices like wearable or home tech.

The ability for people to access our products across multiple devices puts a strain on keeping a continuous relationship with our users. And it’s extremely important to support continuity: multi-device usage can lead to more purchases, engagement and brand loyalty, whereas lack of continuity chips away at customer satisfaction.

While there are some great conversations happening around multi-device continuity and techniques like responsive design (see Further Reading), there’s not yet a widely established framework by which to judge solutions. Inspired by my mother’s experience, I wanted to brainstorm around borrowing healthcare’s continuity of care framework to reveal best practices for multi-device users.

A common definition of continuity of healthcare is considered the “degree in which a series of discrete healthcare events is experienced as coherent and connected and consistent with the patient’s medical needs and personal context.” Similarly, we might consider that continuity of a product experience is the degree in which a series of discrete product interactions is experienced as coherent, connected and consistent with the user’s context.

Professors Jeannie Haggerty, Robert Reid and colleagues developed one of the most predominant models for healthcare continuity. Their model shows continuity of care as comprised of 3 main segments: informational continuity, management continuity, and relational continuity. I’ll break these segments down and explore how we might use them to elicit multi-device best practices.

And it’s important to note that consistency ≠ continuity. While consistency can be an attribute of a continuous experience, it alone does not ensure continuity.

    1. Informational Continuity

    In healthcare, informational continuity deals with all the data around a patient such as their profile, history and treatment preferences. Good informational continuity means that this information is being collected, saved and shared with with all of a patient’s providers. The medical community has already developed standards for an XML-based Continuity of Care Record (CCR) to improve the accessibility of patient data.

    For ill and healthy patients alike, insurance information, test results, previous visits, medical history, and preference for treatments should be shared with primary care physicians, specialists, nurses, technicians, case managers and caregivers.  This informational continuity ensures patients don’t have to repeat themselves every time they have a new appointment, and reduces the risks of getting conflicting treatments or medications.

    When we think about informational continuity in product experiences, we want to focus on approaches that don’t require users to re-enter information as they move across platforms. 90% of multi-device users use their devices sequentially to achieve a single goal. We need to aim for information synchronization, availability, and portability, especially for any data our customer has taken the time to explicitly provide.

    Aspects of informational continuity

    • Settings
    • Profile information
    • Recent activity/history
    • Notifications
    • Shortcuts (ie, bookmarks)

    Best practices for informational continuity

    Build consumable services.  You may have heard this before, but it’s worth mentioning again. We cannot leverage information if we don’t store and share it using reliable, easily consumable, and synchronized services. Good services are required to provide timely notifications and status updates. Fitbit, the wearable activity tracker company, uses their services to make sure users have an up-to-the-minute readout of activity counts.

    Surface access points to recent activity. Allows users to pick up where they left off by exposing recent searches and other histories.  Users of Google Chrome can access browser tabs they’ve opened on one device from a different device, as well as recent searches via the browser omnibox.

    Honor any saved information. Ensure that anything the user has explicitly saved on one device is available on another. In the case of eBay, a seller can start listing an item on their laptop, save it as a draft, and come back to it on their mobile device.

    Use shortcuts. Coordinate with other services a customer uses. Offer universal login options such as OpenID to leverage a user’s existing profile information. Let a customer share content via social networks, or upload files to a storage provider like Dropbox. By supporting other products, you increase user efficiency and avoid building technologies outside of your core competency.

    Share information with customer service teams. Make sure your customer service team has access to as much customer information as possible to make person-to-person interactions more efficient.

    Users of Google Chrome can access browser tabs they’ve opened on one device from a different device

    On eBay, a seller can start listing an item on their mobile phone, save it as a draft, and come back to it on their ipad or desktop.

    Use universal login options to help someone skip the registration form, which is often redundancy since they've often provided that information elsewhere.

      2. Management Continuity

      Management continuity of healthcare is how a system of providers collaborates on a shared care plan for a patient (and their illness, if applicable). The goal is to provide treatment in a consistent, complementary manner so that services are not missed, duplicated or poorly timed. A system with management continuity has the flexibility to adapt care based on an individual’s changing needs.

      For example, an athlete with a sports injury needs a plan that accommodates his acute issues as well as long-term rehabilitation. The athlete needs a structured path so he can transition from emergency care, which is focused on rest and pain control, to physical therapy, which is focused on active strengthening. His care plan also needs to be able to adjust if he experiences a re-injury.

      When it comes to looking at management continuity through the lens of product design, it is about more than just feature parity.  We want to create product experiences that recognize the context they’re being accessed from and adapt accordingly.  They should complement each other, while having consistency in information architecture. Products should also adapt to contexts to be relevant and avoid unnecessary redundancy.

      Aspects that contribute to management continuity

      • Device type
      • Location
      • Time of day
      • The activity
      • Information architecture

      Best practices for management continuity

      Map the customer journey.  Conduct user research and data analysis to understand a “day in the life” of your user and the activities they do. Determine the role that certain devices play, or can play, in each of these scenarios or activities.

      Consider Fitbit’s product ecosystem. There is an activity tracker, responsible for logging steps and stairs and other things. It is built to wear, so it’s lightweight and has a simple readout of only that day’s activity stats. There is a scale, which gathers and displays weight information. But when you use the product on mobile or web, the amount of information shown is progressively increased, with a simple day-by-day dashboard on mobile and the ability to dive into more in-depth historical comparisons on the web.

      Complement each other. Once you understand the customer journey, you can determine how to best build your products so they provide complementary experiences. Just like how there are doctors in different specialties, you might want to focus on the unique specialties of each product in your ecosystem to enhance the experience in that context.

      Adapt to the situation. Use those contexts you can gather from the device–activity, location, time of day–to help prioritize the content for your user. Google Now on your mobile device will pay attention if you travel between two of the same locations at approximately the same time every day, and will start showing you a traffic card with the estimated time for that commute, if you open it during that timeframe. The key is that the product allows you to scroll that information away or dismiss it. There is a difference between limiting content based on context, and prioritizing it.

      Leverage common/expected device standards. At the same time you’re building continuity between your own experiences across many devices, you need to maintain continuity between other experiences on the same device. Don’t sacrifice an expected OS/device interaction to avoid rewriting code. For example, don’t frustrate users by disabling pinch-to-zoom on images they’re viewing on their smartphone. The key is balance; you can support these expected interactions without destroying the continuity of your experience.

      Lay out content appropriately for the device…. Whether your experience is a responsively-designed website or built as separate experiences, lay out content by considering the device’s orientation, screen size and display constraints.

      …But have a consistent information architecture.  Don’t force customers to relearn your product’s structure every time they change contexts. Twitter’s desktop site, mobile app, mobile website and tablet app present their navigation and content in ways best suited to the platform, but share the same IA.

      Fitbit distributes data and information across their product ecosystem; their wearable trackers focus on single-day activity readouts; the scale allows multiple users and weight tracking, and the mobile app up through the website show a progressively more informative dashboard.

      Google Now attempts to prioritize "content cards" based on time of day, historical activity and location

      While Twitter changes the location and density of its navigational elements based on the device being used, the information architecture is the same across all.

      3. Relational Continuity

      The third and last area of healthcare continuity, relational continuity, is the establishment of sustained contact between a patient and a provider.  It involves creating a sense of trust, making the patient feel that they’re recognized as an individual, and setting predictable, positive expectations for future interactions.  The resulting patient-provider loyalty can reduce stress on both sides and increases the likelihood that the patient will follow-up with prescribed instructions.

      My mother had a very strong relationship with her oncologist. He was candid but respectful; he didn’t push her to get aggressive treatments that would compromise quality of life, but made alternative suggestions she may not have otherwise considered. He often followed up to make sure she was doing well. In turn, she trusted his decisions and he was the first person she contacted with any concerns.

      Looking at relational continuity for the multi-device world, it has many elements in common with brand continuity. We want customers to form an emotional connection to our product by establishing trust and being a recognizable, familiar face across all platforms.  Beyond that, we also want to provide personalized experiences to show customers that we value them as individuals.

      Aspects of relational continuity

      • Messaging
      • Visual branding
      • Privacy controls
      • Customer service

      Best practices for relational continuity

      Have a multi-device brand strategy. Create a personality for your product, and be consistent with terminology, messaging and visual design. Apply your strategy to all channels, including emails, phone support and marketing.

      MailChimp created a detailed Voice and Tone guide to ensure multichannel messaging was consistent with their brand.  The BBC has their “Global Experience Language” with overarching principles and guidelines broken down for mobile, tablet, web and television.

      Personalize the experience.  Show the customer that you value them by making enhancements that reflect their activity and interests. Netflix provides movie and tv program recommendations based on your past viewing history. For a shopping tool, you might provide deals tailored to a frequent shopper. For an experienced user, you might progressively disclose–or progressively reduce–elements of the UI. The concept of personalization is intertwined with the aspect of adaptability in management continuity.

      Have clear, editable privacy controls. Establish trust with your customers by being upfront and honest about your privacy policies, and give users control over how information is shared. Facebook has made many improvements in this area by making privacy controls accessible on all devices and making it clearer where to go to make changes.

      Promote customer support. Promote access points so that people can contact your customer service department. Further, prioritize the right contact method for the device–a tablet or laptop might be best suited to chat or email, while a mobile phone or tv may be best suited to a phone call.

      Perfect the details. Pay attention to the little things and customers will appreciate the craft of your product–Apple is a great posterchild of this approach. This includes scrubbing out as many bugs as possible, so invest in a good bug tracking tool like Jira or Bugzilla. I encourage you to read Dan Saffer’s book called “Microinteractions”, which describes how these nuances can differentiate a product users like from a product they love.

      MailChimp created an online voice and tone document to ensure a consistent personality across all of their product channels.

      BBC's "Global Experience Language" is an online document with a multi-device approach to visual brand strategy.

      Netflix personalizes movie/tv show recommendations based on your cumulative viewing history across devices.

      Allow someone to contact your customer service group across all devices, and prioritize the best method for the device and context.


      To increase customer satisfaction, engagement with and loyalty to our products, we want to design experiences that are coherent, connected and consistent with a user’s personal context across devices. While the design community seeks out permanent models for a multi-device ecosystem, I recommend we borrow upon healthcare’s 3-pronged continuity of care framework to help us judge multi-device experiences. The 3 pillars of multi-device continuity as leveraged from the healthcare model are:

      Informational continuity. A product should use services that allow for the synchronization, accessibility and portability of a user’s data, history and preferences across multiple devices and products. Evaluate your product’s informational continuity by asking:

      • What services do we have available?
      • How often do our users repeat actions or re-enter information for the same product on different devices?
      • What shortcuts and 3rd party services do we support?

      Management continuity. Create an experience that can adapt itself to and provide complementary, consistent experiences across a range of devices and contexts.  A product should also solicit feedback to ensure it is meeting a user’s needs. Evaluate your product’s management continuity by asking:

      • Do we have any journey or experience maps?
      • Do we respond to changing contexts (activity, time, location, device type)?
      • Do we have a consistent information architecture?

      Relational continuity. Establish a recognizable brand personality for your products through messaging and visuals. Create a positive relationship with your customer by building trust through transparent privacy and security policies, attention to detail and great customer service. Evaluate your product’s relational continuity by asking:

      • What is our brand strategy? Do we use consistent messaging and look-and-feel across devices?
      • Do we tailor aspects of our experience to individual customers?
      • Are our privacy policies editable across devices?
      • Is our customer service department accessible?
      • Would our customers recommend our product to others (NPS scores)?

      Further reading

      Continuity of care: A multidisciplinary review

      How important is continuity of care?

      Progress with relationship continuity 2012, a British perspective

      Designing for Context: The Multiscreen Ecosystem

      Windows on the Web

      Multi-Device Adaptation vs Optimization


      Special thanks to the folks at the Indiana Continuity of Care Association for providing insight into continuity of care.