Data-driven care for injectable medicine

12 min read

Common Sensing succeeded in bringing a novel smart hardware device from concept to market in a difficult space. It was a healthcare technology company we created to transform home treatment of chronic disease. We developed a smart hardware device that empowered individuals to take control of their health in a highly regulated market where such advancements have been limited.

Our hardware product, Gocap, addressed a significant gap in chronic disease management, particularly for diabetes, the costliest chronic condition in the United States. We recognized that managing diabetes successfully happens outside clinic walls, in patients’ daily routines. Gocap integrates seamlessly into users’ lives, helping them better manage their condition and improve their health outcomes.

Gocap on an insulin pen beside a breakfast plate, at home on the table

We engaged directly with hundreds of users to learn about their daily challenges and preferences. This collaborative process helped us navigate complex regulatory barriers while ensuring Gocap met both healthcare requirements and real user needs. Gocap became more than a medical device; it became an empowering lifestyle tool.

We created Gocap, a connected health product that acts as a “Fitbit for injectable medicine”.

Matt Legrand, James White, Richard Whalley

In the United States, over $400 billion in direct medical costs1 are attributed to diabetes. More than half of diabetes patients are not meeting their treatment goals2. The diabetes treatment market is comparable in size to the entire consumer electronics industry, yet if half of Americans struggled this way to get value from all consumer electronics, it would signal an industry crisis.

I met my cofounders, Rich and Jamie, following a service design initiative I led at IDEO focused on insulin adherence. Gocap was conceived as a smart, connected cap for insulin pens that captures each dose without disrupting the patient’s flow, logs data via Bluetooth to a smartphone app, and allows users to share dosing information with clinicians in real time.

Gocap surrounds patients with a proactive support network. Real-time data sharing with clinicians provides support and accountability, helping both patients and providers catch potential issues early and adjust treatment as needed.

How Gocap works

Gocap replaces the disposable injector pen’s plastic cap with a smart version. Users remove it to take a dose and put it back when finished. Gocap records each dose automatically and transmits it to the user’s mobile app via Bluetooth.

The Gocap system: the smart cap, an insulin injector pen, and the companion mobile app

The smart cap replaces the existing plastic cap that comes with insulin (and other medicine) disposable injector pens. When a user takes a dose, they simply remove the cap and place it back when finished. Gocap logs the dose amount and transmits it to the user’s companion mobile app over Bluetooth.

The companion app gives users a real-time view of their dosing history and patterns. Users can share this data with healthcare providers, allowing for continuous monitoring and support between doctor visits.

Getting the hardware right

Designing IoT hardware like Gocap is challenging due to limited iteration once production begins. Early prototypes used on-demand 3D printing, but full-scale production required expensive ABS molds costing up to $80K each. The product needed to be nearly flawless by manufacturing, as changes become costly.

Interactive 3D model of the Gocap smart cap
Exploded view of Gocap's componentsExploded view of Gocap's components

Gocap consists of an inner and outer plastic shell, a flexible printed circuit board, and a lens cover above the display.

Diagram of Gocap's infrared sensor arrays flanking the pen cavityDiagram of Gocap's infrared sensor arrays flanking the pen cavity

The measurement hardware uses an array of infrared LEDs and a corresponding array of sensors that sit on either side of the injector pen cavity.

One significant change was moving from an LCD to an OLED display. The OLED screen provided a versatile interface that could accommodate various information displays on a single SKU, allowing us to handle different user needs without requiring separate hardware versions.

I was particularly interested in the perceived differences in objects we have to use and objects we want to use. Many objects that meet health needs are perceived as scary, unappealing, or unworthy of public display. Not so for eyeglasses; they’re an article of fashion, even though they serve a medical purpose: correcting vision. What’s the delta between eyeglasses and a hearing aid?

By placing Gocap’s industrial design within the design language of consumer wearables and lifestyle products, we created a tool that people actually wanted to incorporate into their daily routine.

Co-designed by Gocap users

To ensure Gocap was intuitive and practical, especially for older adults managing diabetes, we conducted hundreds of hands-on usability studies. With terabytes of GoPro footage, we captured every movement, challenge, and triumph as users interacted with early prototypes, allowing us to refine every detail from grip comfort to display readability.

These studies aligned with FDA guidelines on user-centered design while helping us identify and resolve usability barriers. This collaborative approach ensured that Gocap felt empowering and accessible to its users.

Packaging design for easy onboarding

Since Gocap wouldn’t always be deployed in person, users needed to set up Gocap with their injectable medicine, charge it, download the app, and sync it over Bluetooth, all without intervention. Gocap’s packaging design made this possible by providing affordances and education during the unboxing process.

I produced marketing and educational materials like this video, the packaging itself, the Gocap website, and so on completely in-house, using resources from our shared hacker space, Industry Lab.

Designing the Gocap App presented unique challenges. Over a third of prospective users had never owned a smartphone before, so we had to rethink conventional digital design norms. Traditional affordances and cues were ineffective for this audience. I designed an interface for iOS and Android based on innovative, simplified guidelines:

  1. No navigational UI. Menus, drawers, and tabs were eliminated to prevent essential information from being hidden or difficult to find. The interface was designed to be as direct as possible.
  2. One screen, one action. Each screen shows only what users need to see at that moment, reducing cognitive load and guiding them step-by-step through their tasks.
  3. Low reliance on iconography. Icons were minimized and replaced with clear text labels, allowing users to understand and interact without needing to interpret unfamiliar symbols.
  4. Use color to create a sense of category and place. Consistent color-coding for core categories like medication types, glucose levels, and alerts helped users quickly orient themselves and understand each section’s purpose at a glance.
A spread of Gocap app screens: dose logging, glucose entry, reminders, and history

Gocap Dash let care providers focus on patients that need their attention.

The care ecosystem for injectable medicine is intricate, involving patients, families, caretakers, healthcare providers, payers, and pharmacies. Gocap enabled data sharing with approved parties throughout this ecosystem, delivering insights that reduce costs and improve care quality.

We developed Gocap Dash, a web application that highlights actionable insights from patient data. Gocap Dash organizes patient information at a population level, categorizing individuals by risk and identifying those in need of immediate intervention. Real-time dose information allows providers to monitor adherence closely, while built-in analytics identify behavioral patterns linked to treatment outcomes.

Gocap Dash population view listing patients stratified by risk

Gocap Dash is a web application for care providers that shows population-level stratification, real-time dose information, categorizes patients based on risk, identifies intervention needs, and characterizes correlated behaviors.

Gocap Dash patient detail view charting doses against glucose over time

The dashboard’s analytics surface patterns in patient behavior that correlate with treatment outcomes, enabling providers to deliver more personalized, proactive care and catch potential issues before they escalate.

A unique problem: optimizing for fax machines

Not everyone in the care ecosystem could take advantage of Gocap Dash’s power. Many care providers were stuck using older computers running Windows XP after its end-of-life3, or weren’t able to connect to the internet from systems where they handled patient information. We discovered that sending patient records over fax was one of the most common methods for transferring protected health data.

We implemented PDF exports and direct-to-fax capability, optimizing data visualizations to render well in the low-pixel scan area available in a typical fax.

Clinical outcomes

In partnership with the Joslin Diabetes Center, we conducted a pioneering connected health study that revealed Gocap’s tangible impact on clinical outcomes. The study demonstrated that Gocap users experienced improved health outcomes, including better insulin adherence and a reduction in missed doses.

Beyond individual outcomes, the study unearthed valuable insights into insulin use behavior on a broad scale. For the first time, we documented widespread challenges with insulin dosing, identifying specific patterns of non-adherence that had previously gone unnoticed. This behavioral data equipped healthcare providers with critical information, enabling them to address these issues proactively and develop more personalized treatment approaches.

Without Gocap, most people who use insulin have no access to data-driven support.

While most treatments for diabetes focus on patients with insulin pumps, this represents around 350k people who use insulin4. There are more than 7.2 million Non-pump insulin users in the United States5, with no dose data.

Gocap identifies dangerous behaviors and increases safety.

A Joslin study patient was stacking doses over and above their prescription. Gocap data illuminated how dose stacking resulted in hypoglycemia.6

1475714546405101520253035050100150200250300350time (hours)mg/dL1475714546401020300100200300time (hours)mg/dL
GlucoseBasal doseBolus dose

Gocap identified users who were modifying their doses off-prescription.

Some Joslin study patients took amounts that differed substantially from their prescribed dose amount. Some users were very adherent, but needed a change to their prescription.7 For example, one patient demonstrated more glucose levels in range when taking their doses higher than their prescribed amount.

0501001502002503003504000100200300400mg/dL at dose timemg/dL 3 hours after81 mg/dL at dose time, 139 mg/dL 3 hours after115 mg/dL at dose time, 300 mg/dL 3 hours after124 mg/dL at dose time, 68 mg/dL 3 hours after129 mg/dL at dose time, 104 mg/dL 3 hours after135 mg/dL at dose time, 71 mg/dL 3 hours after140 mg/dL at dose time, 132 mg/dL 3 hours after142 mg/dL at dose time, 95 mg/dL 3 hours after142 mg/dL at dose time, 97 mg/dL 3 hours after144 mg/dL at dose time, 133 mg/dL 3 hours after147 mg/dL at dose time, 172 mg/dL 3 hours after155 mg/dL at dose time, 96 mg/dL 3 hours after158 mg/dL at dose time, 165 mg/dL 3 hours after158 mg/dL at dose time, 182 mg/dL 3 hours after161 mg/dL at dose time, 60 mg/dL 3 hours after161 mg/dL at dose time, 184 mg/dL 3 hours after162 mg/dL at dose time, 86 mg/dL 3 hours after162 mg/dL at dose time, 181 mg/dL 3 hours after165 mg/dL at dose time, 50 mg/dL 3 hours after166 mg/dL at dose time, 50 mg/dL 3 hours after167 mg/dL at dose time, 63 mg/dL 3 hours after167 mg/dL at dose time, 232 mg/dL 3 hours after171 mg/dL at dose time, 101 mg/dL 3 hours after174 mg/dL at dose time, 92 mg/dL 3 hours after174 mg/dL at dose time, 97 mg/dL 3 hours after175 mg/dL at dose time, 47 mg/dL 3 hours after175 mg/dL at dose time, 82 mg/dL 3 hours after176 mg/dL at dose time, 128 mg/dL 3 hours after181 mg/dL at dose time, 61 mg/dL 3 hours after184 mg/dL at dose time, 86 mg/dL 3 hours after189 mg/dL at dose time, 137 mg/dL 3 hours after189 mg/dL at dose time, 214 mg/dL 3 hours after193 mg/dL at dose time, 171 mg/dL 3 hours after194 mg/dL at dose time, 105 mg/dL 3 hours after194 mg/dL at dose time, 195 mg/dL 3 hours after194 mg/dL at dose time, 221 mg/dL 3 hours after198 mg/dL at dose time, 43 mg/dL 3 hours after201 mg/dL at dose time, 244 mg/dL 3 hours after202 mg/dL at dose time, 116 mg/dL 3 hours after202 mg/dL at dose time, 127 mg/dL 3 hours after203 mg/dL at dose time, 120 mg/dL 3 hours after205 mg/dL at dose time, 156 mg/dL 3 hours after207 mg/dL at dose time, 168 mg/dL 3 hours after211 mg/dL at dose time, 156 mg/dL 3 hours after211 mg/dL at dose time, 197 mg/dL 3 hours after212 mg/dL at dose time, 262 mg/dL 3 hours after213 mg/dL at dose time, 211 mg/dL 3 hours after214 mg/dL at dose time, 161 mg/dL 3 hours after216 mg/dL at dose time, 246 mg/dL 3 hours after219 mg/dL at dose time, 207 mg/dL 3 hours after222 mg/dL at dose time, 253 mg/dL 3 hours after223 mg/dL at dose time, 196 mg/dL 3 hours after224 mg/dL at dose time, 192 mg/dL 3 hours after228 mg/dL at dose time, 209 mg/dL 3 hours after237 mg/dL at dose time, 346 mg/dL 3 hours after238 mg/dL at dose time, 132 mg/dL 3 hours after238 mg/dL at dose time, 321 mg/dL 3 hours after241 mg/dL at dose time, 274 mg/dL 3 hours after242 mg/dL at dose time, 399 mg/dL 3 hours after246 mg/dL at dose time, 203 mg/dL 3 hours after249 mg/dL at dose time, 150 mg/dL 3 hours after251 mg/dL at dose time, 325 mg/dL 3 hours after252 mg/dL at dose time, 135 mg/dL 3 hours after252 mg/dL at dose time, 283 mg/dL 3 hours after256 mg/dL at dose time, 255 mg/dL 3 hours after261 mg/dL at dose time, 211 mg/dL 3 hours after268 mg/dL at dose time, 144 mg/dL 3 hours after273 mg/dL at dose time, 308 mg/dL 3 hours after274 mg/dL at dose time, 71 mg/dL 3 hours after277 mg/dL at dose time, 251 mg/dL 3 hours after282 mg/dL at dose time, 73 mg/dL 3 hours after284 mg/dL at dose time, 208 mg/dL 3 hours after287 mg/dL at dose time, 63 mg/dL 3 hours after289 mg/dL at dose time, 136 mg/dL 3 hours after291 mg/dL at dose time, 141 mg/dL 3 hours after292 mg/dL at dose time, 205 mg/dL 3 hours after298 mg/dL at dose time, 93 mg/dL 3 hours after299 mg/dL at dose time, 209 mg/dL 3 hours after309 mg/dL at dose time, 243 mg/dL 3 hours after309 mg/dL at dose time, 289 mg/dL 3 hours after314 mg/dL at dose time, 121 mg/dL 3 hours after316 mg/dL at dose time, 123 mg/dL 3 hours after316 mg/dL at dose time, 124 mg/dL 3 hours after316 mg/dL at dose time, 313 mg/dL 3 hours after317 mg/dL at dose time, 118 mg/dL 3 hours after317 mg/dL at dose time, 218 mg/dL 3 hours after319 mg/dL at dose time, 96 mg/dL 3 hours after320 mg/dL at dose time, 73 mg/dL 3 hours after322 mg/dL at dose time, 85 mg/dL 3 hours after325 mg/dL at dose time, 268 mg/dL 3 hours after328 mg/dL at dose time, 166 mg/dL 3 hours after329 mg/dL at dose time, 104 mg/dL 3 hours after330 mg/dL at dose time, 249 mg/dL 3 hours after330 mg/dL at dose time, 315 mg/dL 3 hours after338 mg/dL at dose time, 223 mg/dL 3 hours after338 mg/dL at dose time, 232 mg/dL 3 hours after352 mg/dL at dose time, 315 mg/dL 3 hours after354 mg/dL at dose time, 314 mg/dL 3 hours after355 mg/dL at dose time, 302 mg/dL 3 hours after370 mg/dL at dose time, 115 mg/dL 3 hours after01002003004000100200300400mg/dL at dose timemg/dL 3 hours after81 mg/dL at dose time, 139 mg/dL 3 hours after115 mg/dL at dose time, 300 mg/dL 3 hours after124 mg/dL at dose time, 68 mg/dL 3 hours after129 mg/dL at dose time, 104 mg/dL 3 hours after135 mg/dL at dose time, 71 mg/dL 3 hours after140 mg/dL at dose time, 132 mg/dL 3 hours after142 mg/dL at dose time, 95 mg/dL 3 hours after142 mg/dL at dose time, 97 mg/dL 3 hours after144 mg/dL at dose time, 133 mg/dL 3 hours after147 mg/dL at dose time, 172 mg/dL 3 hours after155 mg/dL at dose time, 96 mg/dL 3 hours after158 mg/dL at dose time, 165 mg/dL 3 hours after158 mg/dL at dose time, 182 mg/dL 3 hours after161 mg/dL at dose time, 60 mg/dL 3 hours after161 mg/dL at dose time, 184 mg/dL 3 hours after162 mg/dL at dose time, 86 mg/dL 3 hours after162 mg/dL at dose time, 181 mg/dL 3 hours after165 mg/dL at dose time, 50 mg/dL 3 hours after166 mg/dL at dose time, 50 mg/dL 3 hours after167 mg/dL at dose time, 63 mg/dL 3 hours after167 mg/dL at dose time, 232 mg/dL 3 hours after171 mg/dL at dose time, 101 mg/dL 3 hours after174 mg/dL at dose time, 92 mg/dL 3 hours after174 mg/dL at dose time, 97 mg/dL 3 hours after175 mg/dL at dose time, 47 mg/dL 3 hours after175 mg/dL at dose time, 82 mg/dL 3 hours after176 mg/dL at dose time, 128 mg/dL 3 hours after181 mg/dL at dose time, 61 mg/dL 3 hours after184 mg/dL at dose time, 86 mg/dL 3 hours after189 mg/dL at dose time, 137 mg/dL 3 hours after189 mg/dL at dose time, 214 mg/dL 3 hours after193 mg/dL at dose time, 171 mg/dL 3 hours after194 mg/dL at dose time, 105 mg/dL 3 hours after194 mg/dL at dose time, 195 mg/dL 3 hours after194 mg/dL at dose time, 221 mg/dL 3 hours after198 mg/dL at dose time, 43 mg/dL 3 hours after201 mg/dL at dose time, 244 mg/dL 3 hours after202 mg/dL at dose time, 116 mg/dL 3 hours after202 mg/dL at dose time, 127 mg/dL 3 hours after203 mg/dL at dose time, 120 mg/dL 3 hours after205 mg/dL at dose time, 156 mg/dL 3 hours after207 mg/dL at dose time, 168 mg/dL 3 hours after211 mg/dL at dose time, 156 mg/dL 3 hours after211 mg/dL at dose time, 197 mg/dL 3 hours after212 mg/dL at dose time, 262 mg/dL 3 hours after213 mg/dL at dose time, 211 mg/dL 3 hours after214 mg/dL at dose time, 161 mg/dL 3 hours after216 mg/dL at dose time, 246 mg/dL 3 hours after219 mg/dL at dose time, 207 mg/dL 3 hours after222 mg/dL at dose time, 253 mg/dL 3 hours after223 mg/dL at dose time, 196 mg/dL 3 hours after224 mg/dL at dose time, 192 mg/dL 3 hours after228 mg/dL at dose time, 209 mg/dL 3 hours after237 mg/dL at dose time, 346 mg/dL 3 hours after238 mg/dL at dose time, 132 mg/dL 3 hours after238 mg/dL at dose time, 321 mg/dL 3 hours after241 mg/dL at dose time, 274 mg/dL 3 hours after242 mg/dL at dose time, 399 mg/dL 3 hours after246 mg/dL at dose time, 203 mg/dL 3 hours after249 mg/dL at dose time, 150 mg/dL 3 hours after251 mg/dL at dose time, 325 mg/dL 3 hours after252 mg/dL at dose time, 135 mg/dL 3 hours after252 mg/dL at dose time, 283 mg/dL 3 hours after256 mg/dL at dose time, 255 mg/dL 3 hours after261 mg/dL at dose time, 211 mg/dL 3 hours after268 mg/dL at dose time, 144 mg/dL 3 hours after273 mg/dL at dose time, 308 mg/dL 3 hours after274 mg/dL at dose time, 71 mg/dL 3 hours after277 mg/dL at dose time, 251 mg/dL 3 hours after282 mg/dL at dose time, 73 mg/dL 3 hours after284 mg/dL at dose time, 208 mg/dL 3 hours after287 mg/dL at dose time, 63 mg/dL 3 hours after289 mg/dL at dose time, 136 mg/dL 3 hours after291 mg/dL at dose time, 141 mg/dL 3 hours after292 mg/dL at dose time, 205 mg/dL 3 hours after298 mg/dL at dose time, 93 mg/dL 3 hours after299 mg/dL at dose time, 209 mg/dL 3 hours after309 mg/dL at dose time, 243 mg/dL 3 hours after309 mg/dL at dose time, 289 mg/dL 3 hours after314 mg/dL at dose time, 121 mg/dL 3 hours after316 mg/dL at dose time, 123 mg/dL 3 hours after316 mg/dL at dose time, 124 mg/dL 3 hours after316 mg/dL at dose time, 313 mg/dL 3 hours after317 mg/dL at dose time, 118 mg/dL 3 hours after317 mg/dL at dose time, 218 mg/dL 3 hours after319 mg/dL at dose time, 96 mg/dL 3 hours after320 mg/dL at dose time, 73 mg/dL 3 hours after322 mg/dL at dose time, 85 mg/dL 3 hours after325 mg/dL at dose time, 268 mg/dL 3 hours after328 mg/dL at dose time, 166 mg/dL 3 hours after329 mg/dL at dose time, 104 mg/dL 3 hours after330 mg/dL at dose time, 249 mg/dL 3 hours after330 mg/dL at dose time, 315 mg/dL 3 hours after338 mg/dL at dose time, 223 mg/dL 3 hours after338 mg/dL at dose time, 232 mg/dL 3 hours after352 mg/dL at dose time, 315 mg/dL 3 hours after354 mg/dL at dose time, 314 mg/dL 3 hours after355 mg/dL at dose time, 302 mg/dL 3 hours after370 mg/dL at dose time, 115 mg/dL 3 hours after
Dose within rangeDose above prescriptionDose below prescription

Gocap serves more than 7 million patients whose data was previously invisible to their clinicians and themselves.

After proving Gocap’s safety, efficacy, and usability through rigorous trials, we partnered with connected glucose meters and injectable pens to offer Gocap as part of comprehensive, bundled solutions. This approach “closed the loop” for clinicians and patients alike. Clinicians gained a clear, data-driven view of their patients’ adherence, while patients received the insights they needed to take control of their treatment.

As Gocap matured, we expanded beyond insulin to other high-risk injectable medications, such as hormone therapies and fertility treatments. Today, Gocap serves over 7 million patients, making once-invisible data accessible and actionable.

Acquisition & Exit

In 2021, Common Sensing was acquired by Bigfoot Biomedical. By joining Bigfoot, Gocap became part of a fully integrated diabetes care solution, combining connected glucose monitoring, insulin management, and treatment adherence.

Bigfoot had already assembled the other essential pieces of the connected health puzzle. Integrating Gocap into this ecosystem allowed us to deliver a complete, seamless solution. Through Bigfoot, Gocap continues to transform how chronic disease is managed on a large scale.

Press & Links

Notes

  1. American Diabetes Association, “New American Diabetes Association Report Finds Annual Costs of Diabetes to be $412.9 Billion,” 2023 ↩

  2. Stuart A. Ross, “Breaking Down Patient and Physician Barriers to Optimize Glycemic Control in Type 2 Diabetes,” The American Journal of Medicine, September 2013 ↩

  3. “IoT Threat Report,” Palo Alto Networks, March 10, 2020 ↩

  4. Brooke H. McAdams and Ali A. Rizvi, “An Overview of Insulin Pumps and Glucose Sensors for the Generalist,” Journal of Clinical Medicine, January 4, 2016 ↩

  5. Israel Hodish, “Decades Into Diabetes, Insulin Therapy Still Hard to Manage,” The Conversation, November 14, 2016 ↩

  6. Medha N. Munshi, Christine Slyne, Tara MaNeil, Joslin Diabetes Center, Harvard Medical School, et al. “Nonadherence to Insulin Therapy Detected by Bluetooth-Enabled Pen Cap Is Associated With Poor Glycemic Control,” Diabetes Technology & Therapeutics, March 2019 ↩

  7. Toschi E, MD, Carl S, Greenberg J, BS, Greaves T, BS, Atakov-Castillo A, BA, Slyne C, BA, Munshi M, MD. “Use of Gocap to evaluate appropriateness bolus insulin dosing to achieve target glucose levels in patients on basal bolus regimen,” February 2018 ↩