Friday 21st July, time tbc
Roger Donald (NHS Direct) & Kevin White (Nile)
Self-service health care
This document and it’s ...
TIM KELSEY
NATIONAL DIRECTOR FOR PATIENTS AND INFORMATION IN THE NHS
“We have to deliver an
NHS that responds to
the needs...
The economics
* DH Reference Costs 2009/10
** PSSRU Unit Costs for Social Care 2009/10
*** Connecting for Health/Universit...
NHS Direct symptom checkers
Decreasing demand on core NHS services
Online symptomatic health assessments
Self care
advice
online
Web chat
with NHS
Dir...
Why multi-channel for health?
Why should we do this?
What services do users
want?
How do they engage with
them?
Does chann...
Multi-channel health care
Channel Access Fulfilment
Face to Face
• Urgent Transport
• Car + Parking
• Bus + Walk
• Rail + ...
Taking control of your health
Taking control of your health
Taking control of your health
Taking control of your health
Taking control of your health
Taking control of your health
Taking control of your health
Taking control of your health
NILE’S BIT
Interviews and persona development
Grant Ingram
Chronic Sufferer
Age: 62
Semi-retired mechanic.
Works at local Halfords
“I...
IA Development and testing
Always read the label
Safe, evidenced-based, clinical content is
paramount
But…
– Users may not read text
– Users may misr...
Clinical clinical content
Interactive decision points
Patient decision aids
Patient decision aids
Patient decision aids
High stress conditions
Potentially high risk interventions
Helpful, reassuring information
Visualisa...
Calming messages
What do people want?
What do people want?
Respondents indicated the following as very valuable
features
• Text explaining how to deal with symp...
What do people want?
And if all their questions weren’t answered they would
value
• Telephone callback (48%, N=871)
• Webc...
What do people want?
And if they were still unwell, they would be inclined to
• A face-to-face consultation (64%, N=858)
•...
CHALLENGES AND
QUESTIONS
Quick response
Is a 4 hour call
back wait
acceptable?
Do instant
webchats drive an
expectation?
What would you do?
“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...
Expected disposition
Urgency of end point given
Low Medium High
Urgencyof
user’s
favoured
endpoint
Low 53% 44% 10%
Medium ...
New ways of interacting
Testing with people in distress
Testing with people in the right context
More serious conditions
Alternative methodologies
• Ethnography
• Theatre studies
• Mobile ethnography
• Co-creation
THE FUTURE
Interconnected future
Symptom
checking
Self care
Appt.
booking
Condition
information
Prescription
mgmt.
Decision
support
L...
NHS Digital service roadmap
Future services –
beyond 2015
MyNHS from 2015Existing Services
From 2013
YOUR QUESTIONS
Takeaways
Methodologies need to develop to allow us to
connect with distressed or otherwise contextually
relevant particip...
UX Scotland Conference 2013 - Selfservice Healthcare
UX Scotland Conference 2013 - Selfservice Healthcare
UX Scotland Conference 2013 - Selfservice Healthcare
UX Scotland Conference 2013 - Selfservice Healthcare
UX Scotland Conference 2013 - Selfservice Healthcare
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UX Scotland Conference 2013 - Selfservice Healthcare

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Presentation from Kevin White, Nile and Roger Donald, NHS for UX Scotland Conference 2013

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  • 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.
  • UX Scotland Conference 2013 - Selfservice Healthcare

    1. 1. Friday 21st July, time tbc Roger Donald (NHS Direct) & Kevin White (Nile) Self-service health care This document and it’s content is Copyright ©2012 NHS Direct, Nile HQ and UCD UK Limited.
    2. 2. TIM KELSEY 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
    3. 3. The economics * 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 £219 £95 £32 * ** * £8-12 £0.44 *** ****
    4. 4. NHS Direct symptom checkers
    5. 5. Decreasing demand on core NHS services Online symptomatic health assessments Self care advice online Web chat with NHS Direct Call-back from NHS Direct Pharmacy Referred to GP, A&E, Dentist or 999
    6. 6. Why multi-channel for health? Why should we do this? What services do users want? How do they engage with them? Does channel effect activity? Do we do it simply because it is there?
    7. 7. Multi-channel health care Channel Access Fulfilment Face to Face • Urgent Transport • Car + Parking • Bus + Walk • Rail + Walk • Walk • A&E • GP • GP OOH • WIC • MIU Telephone • 999 • 111 • 0845 4647 • TAL • Ambulance • A&E • GP • WIC/MIU • Self-care Advice • Information • Appointments Digital • Choices (nhs.uk) •nhsdirect.nhs.uk • net doctors • GP web site • Ambulance • A&E • GP • WIC/MIU • Self-care Advice • Information • Appointments “Channels are not alternatives, they are complements. It is only by appropriately combining channels that organisations can improve customer experience and make step-change improvements in efficiency at the same time” Professor Hugh Wilson Cranfield School of Management
    8. 8. Taking control of your health
    9. 9. Taking control of your health
    10. 10. Taking control of your health
    11. 11. Taking control of your health
    12. 12. Taking control of your health
    13. 13. Taking control of your health
    14. 14. Taking control of your health
    15. 15. Taking control of your health
    16. 16. NILE’S BIT
    17. 17. Interviews and persona development Grant Ingram Chronic Sufferer Age: 62 Semi-retired mechanic. Works at local Halfords “I need reassurance and the possibility to talk to someone” Julie Warrington Parent with toddler Age: 32 Mum and part-time voice-over actress “I don’t want to waste GPs’ time with little things” Alayah Roberts Mostly healthy Age: 23 Recruitment consultant “Easier than going to the doctor”
    18. 18. IA Development and testing
    19. 19. Always read the label Safe, evidenced-based, clinical content is paramount But… – Users may not read text – Users may misread important information – Users may misunderstand important information
    20. 20. Clinical clinical content
    21. 21. Interactive decision points
    22. 22. Patient decision aids
    23. 23. Patient decision aids
    24. 24. Patient decision aids High stress conditions Potentially high risk interventions Helpful, reassuring information Visualisations and supporting diagrams Real life stories
    25. 25. Calming messages
    26. 26. What do people want?
    27. 27. What do people want? Respondents indicated the following as very valuable features • Text explaining how to deal with symptoms (43%, N=853) • Tips from individual doctors or nurses on self-care (45%, N=874) • Information on medicines which would be effective (51%, N=871)
    28. 28. What do people want? And if all their questions weren’t answered they would value • Telephone callback (48%, N=871) • Webchat(28%, N=838) • Email contact (25%, N=842) • Live webcam or audit chat (17%, N=829)
    29. 29. 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)
    30. 30. CHALLENGES AND QUESTIONS
    31. 31. Quick response Is a 4 hour call back wait acceptable? Do instant webchats drive an expectation?
    32. 32. What would you do?
    33. 33. “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
    34. 34. Expected disposition Urgency of end point given Low Medium High Urgencyof user’s favoured endpoint Low 53% 44% 10% Medium 65% 80% 33% High 74% 78% 70% Percentage chance that a user will comply with advice
    35. 35. New ways of interacting
    36. 36. Testing with people in distress
    37. 37. Testing with people in the right context
    38. 38. More serious conditions
    39. 39. Alternative methodologies • Ethnography • Theatre studies • Mobile ethnography • Co-creation
    40. 40. THE FUTURE
    41. 41. Interconnected future Symptom checking Self care Appt. booking Condition information Prescription mgmt. Decision support Long term condition mgmt. Wellness Social care support Care provider information Directory of services Discharge support
    42. 42. NHS Digital service roadmap Future services – beyond 2015 MyNHS from 2015Existing Services From 2013
    43. 43. YOUR QUESTIONS
    44. 44. Takeaways Methodologies need to develop to allow us to connect with distressed or otherwise contextually relevant participants 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 their healthcare

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