We can see that every time you call 999 for an ambulance, it costs £219If you go to A&E, and are seen by a doctor, without any tests or treatments, it costs £95. Your GP costs around £32 for a 10 minute appointmentCompare that to the remote channels –On the telephone, the latest figures on NHS 111 reference price puts it at around 8 – 12 pounds per call, Or better still, a patient treating themselves with digital information can cost as little as five penceWe saw a couple of slides ago the millions of contacts per year that we deal with digitally, and that creates a signficant number of people who then do not need to attend one of the traditional routes to healthcare
As a consumer I expect the same quality of service from John Lewis, Boots in-store as I do online. The same is true for NHS Direct – no matter which channel citizens contact us through we provide the same highly valued, clinically safe service.The range of channels is now vast to say nothing of the individual engagement outlets and needs within them.MMS and SMS messaging.Smart phones and tablets encroach on the computer market.Ebook readers are a new market selling in millions of units and all of them are connected to the web.The logical answer is to provide healthcare services through the majority of them
Citizens are more inclined to be searching for health information and advice online (third most popular activity online in the US, Pew report - http://tinyurl.com/454oysx)So let’s consider a future vision of how the NHS could look.Alayah is a 23 year old female. She has recently had her ear pierced, but in the last few days it has become red, sore an inflamed.Alayah logs on the NHS symptom checker tool from her laptop.
Last year, Professor Sir Bruce Keogh, the NHS Medical Director suggested that online consultations could become the norm for patients.In this case, Alayah could have an online video conference (we will return to this later) with a clinician, who can see the problem for themselves, and use this, along with other signs and symptoms, to come an appropriate conclusion which keeps the patient out of expensive primary care.
A remote clinician could refer on to a pharmacy for professional advice, and appropriate medication.Maybe in the future, this could extend to online remote prescribing, especially for recurrent problems or repeat prescriptions.
Julie is a 36 year old female and is concerned that her son, Joshua aged 5, has developed a small red rash, is restless, has a fever and is not taking fluids. She is concerned and it is now Saturday when herGP is shut.
Julie logs on the symptom checker and starts to enter information.
The system looks up services for the local area in the Directory of Service which match the problemthat Joshua is presenting with and determines that an Urgent Care Centre is the best service to look after Joshua at this time.
The system contacts the computer system of the Urgent Care Centre for the area, and requests an appointment. Julie is shown the available options for the Urgent Care Centre and selects an available slot for about 2 hours time
A paediatric specialist from the Urgent Care Centre sees Joshua a couple of hours later and prescribes antibiotics which clear up his condition in a few days.
Nile have been working with NHS Direct since 2009We have helped support and develop the broad online presence
Developed from mix of face to face and depth interviews with a range of representative users. This included input from key stakeholder groups within NHS Direct.
None of this is rocket science, these are straight forward interaction patterns used to encourage people to engage more
Avoiding long chucks of textKeeping the text focused and relevant‘Why?’ is a common question – a lack of answer often leads to frustration
Active interaction will attract attention more than passive readingRather than presenting statements of what to do, present them as interactive components. This is a simple way to encourage engagement, and ensures people read content that could be vitally important.
Choice and control of personal health is an important messageAmount and level of information can make this difficult
High stress issues; cataracts, kidney failure, osteoarthritisMore of the simple usability solutions
Connecting health advice and popular media is a good thing such as the NHS Direct collaboration with Embarrassing bodies. What else are people after.Recent online survey (N=1592) regarding upcoming changes that 111 will bring explored some of the features that people wanted to see from self-careSome obvious things that people would appreciate e.g. video and imagery
Three stood out particularly as very valuable. The first suggests how people are using their mobile, the second suggests that regardless of the digital channel connecting with individuals is important, third suggests people want that additional bit of help that means they wouldn’t need to visit their GP
Compliance has a major effect on the safety, efficacy, and return on investment of the service.More serious outcomes such as emergency department and 999 have poor compliance as compared with self-care or GP outcomes. Analysis suggests users may receive an outcome and then back up and change answers to gain an alternative outcome.During testing 72% people indicated that they would fully comply. Phone services achieved 81% full compliance.Still about 11% of users of the digital service who have not been convinced. That is 100,000 patients a month.
One of the largest controlling factors within compliance is what the user expected in the first place.Example, for example a user is experience what they think is indigestion and expects some self-care advice. Turns out the answers suggest a heart attack and they end up being told to contact 999.Users expecting a high urgency end point are more likely to accept any disposition. This may be indicative of a reassurance seeking behaviour.Also, users given a high urgency end point are the least likely to comply. Persuasion is a key factor here.
Initial problems getting camera connected then sound issues
Or even testing with parents with children in distress
Unrealistic acting of symptoms (we had recruited participants based on having the symptoms previously and they were also prompted during a pre-call to be in the mindset of having the symptoms during the session)
For example, ‘Reducing violence and aggression in A&E by design’ http://www.designcouncil.org.uk/our-work/challenges/health/ae/
Modular designInteractive componentsMost importantly, patient led
Existing Services: The existing service is focused on one-off acute problems, with phone and digital not linked to primary careFrom 2013: From 2013, the NHS should introduce more online consultation and appointment booking and set about a period of continuous improvementMyNHS from 2015: From 2015, when patient record access online becomes the norm, the NHS should develop integration around the record, including prescription management, condition monitoring and proactive intervention and care planningFuture services – beyond 2015: In the future, all NHS commissioned services should strive to be integrated across multichannel platforms. One journey, many routes.
NATIONAL DIRECTOR FOR PATIENTS AND INFORMATION IN THE NHS
“We have to deliver an
NHS that responds to
the needs of the people
that use it”
eHealth Insider, http://tinyurl.com/blsjxbj
The Challenge for the NHS
* DH Reference Costs 2009/10
** PSSRU Unit Costs for Social Care 2009/10
*** Connecting for Health/University of Sheffield, Second Interim Report, Oct 11
**** Estimated 2011/12 figure for digital symptomatic assessments - income / users
Decreasing demand on core NHS services
Online symptomatic health assessments
Why multi-channel for health?
Why should we do this?
What services do users
How do they engage with
Does channel effect
Do we do it simply because
it is there?
Multi-channel health care
Channel Access Fulfilment
Face to Face
• Urgent Transport
• Car + Parking
• Bus + Walk
• Rail + Walk
• GP OOH
• 0845 4647
• Self-care Advice
• Choices (nhs.uk)
• net doctors
• GP web site
• Self-care Advice
“Channels are not
alternatives, they are
complements. It is only
that organisations can
experience and make
efficiency at the same
Professor Hugh Wilson
Cranfield School of Management
Interviews and persona development
Works at local Halfords
“I need reassurance and
the possibility to talk to
Parent with toddler
Mum and part-time
“I don’t want to waste
GPs’ time with little
“Easier than going to the
What do people want?
Respondents indicated the following as very valuable
• Text explaining how to deal with symptoms (43%, N=853)
• Tips from individual doctors or nurses on self-care (45%,
• Information on medicines which would be effective (51%,
What do people want?
And if all their questions weren’t answered they would
• Telephone callback (48%, N=871)
• Webchat(28%, N=838)
• Email contact (25%, N=842)
• Live webcam or audit chat (17%, N=829)
What do people want?
And if they were still unwell, they would be inclined to
• A face-to-face consultation (64%, N=858)
• Phone consultation (42%, N=854)
• Accident and emergency (34%, N=847)
• Online consultation (28%, N=830)
“It told me to go to A&E for a cold …
I mean why would I go to accident
and emergency for a common cold”
– From iPhone App review
Urgency of end point given
Low Medium High
Low 53% 44% 10%
Medium 65% 80% 33%
High 74% 78% 70%
Percentage chance that a user will comply with advice
NHS Digital service roadmap
Future services –
MyNHS from 2015Existing Services
Methodologies need to develop to allow us to
connect with distressed or otherwise contextually
Strong reassurance seeking behoviour
Multichannel does not necessarily mean the same
thing on every channel
The future aims to put the user at the centre of