Involving end users in the design process can be challenging and in many cases fails to become a priority for system developers. This is also the case with numerous applications in the health care domain. This article focuses on the design process for applications intended for direct use by the patients themselves, often referred to as self-help tools. A framework for the user involvement in the design process is presented. This framework is inspired both from existing methods and standards within the field of human computer interaction, as well as documented experiences from relevant e-health projects. An analysis of three case studies highlights the importance of patient involvement in the design process and informs guidelines for patient-centric system design.