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Smart phone displaying screen from attune stress management support app.


Securing user engagement and $26M+ in funding


Digital therapeutics company Blue Note and its team of cancer doctors, patients, and researchers had started designing a mobile app to deliver a clinically tested stress management program

Needed to figure out how to build community, support, and trust in a digital environment, but their early designs lacked features to help users connect


New community engagement feature designed and implemented to complete MVP ahead of schedule

Beat deadline for regulatory fast-tracking and secured $26+ million in series A funding

Overhauled backend infrastructure to empower rapid updates, service capacity, and HIPAA compliance


Closing the care gap

About one in four cancer patients suffers from depression, but many of them lack access to conventional forms of therapy. Blue Note Therapeutics’ attune mobile app puts proven stress management tools and guidance right at their fingertips to support their mental, physical, and emotional health—with potentially life-changing results.


Remaking “group” for a new medium

We worked with the Blue Note team to identify and understand the essential components of the group therapy model: the scheduled group sessions and the group facilitation. We also conducted user research that validated the need for a group communication component to encourage patient engagement. Then, we designed a platform that combined the existing self-paced user journey with a new private group discussion feature for program participants.


Enhanced onboarding

We expanded the onboarding flow to support group communication with new fields like photo/avatar and condition information to promote trust and empathy among participants, and to facilitate the possibility of customized segmentation in future groups.


QMS partnership for top-tier compliance

We worked with a third-party quality management system (QMS) to develop and maintain software products within a formally documented software development environment.


Enabling inclusive conversations

With accessibility and equity in mind, we developed group discussion prompts designed to resonate with patients from many backgrounds. We participated in feedback sessions with focus groups of diverse patients, clinicians, and advocates to craft prompts with content, tone, and language that would be understandable, relevant, and respectful to attune users.


A better way(finding)

To optimize the user experience, we created a navigation structure that forwards the patient’s therapeutic journey while making other important features discoverable and accessible. By configuring key elements in standard iOS patterns, we enabled participants to easily move back and forth between the session roadmap and the group chat forum, without losing focus or motivation.


Re-engineered for success

We restructured Blue Note's early iteration app to dramatically improve its performance and scalability. We replaced sub-optimal php and javascript with typescript on the back and front ends, incorporated automated build, and implemented an extensive infrastructure-as-code backend that supported HIPAA compliance.

Praise from our clients:

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The technical team has been a great strategic partner, looking far beyond the scope of the project to our long-term needs and helping us make good choices.

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Michael McKinley

Blue Note Therapeutics, Head of Product

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Working with Twenty Ideas has been a game-changer for a science-based start-up like us. They showed genuine investment in our mission to ease the burden of cancer, in their attention to detail and quality, and their commitment to serve patient users.

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Geoffrey Eich

Blue Note Therapeutics, CEO

Featured Technologies

React native logo

React Native for Mobile App

  • iOS & Android on mobile & tablet
  • Push notifications
  • Twilio SMS integration
AWS logo

AWS Infrastructure as Code

  • AWS CDK & Cloudformation
  • Continuous integration & continuous build (CI/CD)
  • Multi-environment architecture
Amplitude logo

Amplitude Analytics

  • Analytics strategy
  • Detailed implementation plan
supported HIPAA compliance logo

HIPAA Compliance Support

  • Infrastructure & code
  • Work with Enzyme’s quality management system (QMS)
TypeScript and Nest.js logos

Server with TypeScript & Nest.js

  • Integration with patient management system (PMS)
  • Integration with prescription system

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