The Design of Healthcare
A great evening of sessions looking to understand the digital landscape of healthcare to help design for it, hosted by After the Flood.
Matt Harrington — Product Manager in the NHS at the Department of Health
Matt was previously at the GDS — focussed on the transparency of government as a service.
Digital started off at the DOH as an assurance and risk management function. Anything that had a user facing view, had to go through the team. However they didn’t have a huge amount of insight into any particular project, but they would still have to decide how these would move forward and provide sign off. This was an untenable situation which both got in the way for the teams on the ground and didn’t drive quality for the end user.
The natural move for this team was into consulting with those that were running these projects and helping them to build their skills to help ensure quality end products. This is what he’d learnt through this process.
The scale of the NHS is 1.4million employees and a budget of £113Bn. This translates to more than 3,000 websites across 9,000 organisations.
To support these various stakeholders, they started to do a lot of user research. What they learned is that Health is a journey that starts when you decide to go see a doctor. At the moment, the NHS feels more like random destinations on that journey, rather than something which is a connected experience.
An example of this is the online registration with GP practices — which sits across at least 6 different teams, not considering that each of the UK’s thousands of GP surgery are a business in their own right.
The single biggest learning from their user testing was that not everyone wants to manage every part of their condition. For many people, health is not their single biggest priority. Many would put work and family ahead of their type 2 diabetes no matter what tools you give them.
Some of the challenges that exist to driving change within the NHS:
- The complex environment means that people are reticent to make decisions as no single person can know the downstream impact
- The highest paid person in the room (HIPPOs) are usually the ones that are listened to, regardless of whether they’re best placed to make the decision
- There is a big fear of missing out on projects that start when they try and do everything at once. This results in having enormous levels of stakeholder engagement at the start of initiatives which can paralyze them before they start. One of the most surprising benefits of working iteratively, was that you could cut down this stakeholder group and involve people at subsequent stages.
What the future holds for the NHS:
- The NHS is actually a collection of many different organisations, but needs to act like a single one. This is the greatest opportunity for digital within the healthcare sector right now.
- Turning the vision for a paperless, technology embracing organisation into a reality through user research and iterative delivery.
NHS.UK alpha
- Set up in June 2015 to see how things could be done differently
- Aim is to find an agreed, clear vision for NHS.uk
- Important to define the next steps so that any prototype isn’t just there for the fun of it. Similar projects have been started before with nothing making it to scaled delivery.
- User interviews were the starting point — crucially including observation studies
- Resulted in 4 services being prototyped, including Booking a GP appointment online
Some of the challenges they face:
- It’s quicker to call and you’re more likely to get an early appointment as you can negotiate depending on severity
- Log in details are a perennially difficult problem as they’re all different
- Often appointments aren’t put online by the GP practice due to skewed targets and KPIs
- GPs are naturally nervous about moving to online system
- Currently only 4% of GP appointments are made online
- Gold standard for everyone is still face to face
“Do the hard work to make it simple” GDS
The DOH Digital team are applying the GDS’ oft quoted approach of ‘Do the hard work to make it simple’. They want to understand what’s underneath the needs and fears of all stakeholders so that they can build a product that genuinely meets users needs. Stay tuned!
Sarah Gold — Director of projectsbyif.com
If are an agency that “make things that change how people think about data, privacy and security”.
They are huge advocates for the benefits of putting people in control of their data and companies being open and honest about how they use it.
What questions should we be asking about ethics and policy in the digital age?
DeepMind are interested in how to illustrate to clinicians what information they are collecting through Streams and why and then what it’s doing with it. They’re creating numerous interventions with doctors to help them understand why it’s asking for certain data and where it will end up.
Recently, DotEveryone have been working with those people who are ‘super users’ of the NHS, who are also likely to have less than a year to live. They too have found that healthcare isn’t always people primary focus in their life. One of the areas they focussed on was how people are told about their conditions.
This hasn’t changed for a very long time — and is still largely explained through jargon. This results in people losing control of their information when diagnosed. They aren’t given a full understanding of the condition of the treatment and are still expected to make decisions almost right away.
This results in the patient beginning to lose control of their own treatment, having to act between lots of different agents who are trying to help them. This puts them as the integrator between organisations and can leave them with an ad hoc system of understanding at best.
There is a clear opportunity for digital tools to play a role at this stage and provide a support for people when they find out about their condition.
“Users are communicating their needs when they break the rules” Rachel C, Sociotechnical Security Researcher NCSC
Design is ethics is policy. In order to make things that give users what they need whilst still maintaining a respect for privacy and the rule of law, we need to consider them all at the same time rather than trying to tackle in silo.
Ophelia Brown from Local Globe — what does a VC look for when they decide to invest in Digital Health Startup?
In VCs you’re looking for the outliers — but at the stage you’re working with them it’s likely just going to be a couple of people with a big idea. Hopefully you they’ve got an MVP, but not always.
Local Globe believe London is where Silicon Valley was in the 90s — with many graduates and smart people thinking that investment banking, consultancy etc are no longer the best career paths. This is combined with a number of serious investors and the infrastructure to support them in scaling.
Startups, science and NHS ecosystems have an opportunity to be working together to deliver better health outcomes — a unique opportunity for the digital healthcare industry. The difficulty in the UK is that we’re not used to paying for anything relating to healthcare thanks to the NHS.
However, the NHS is facing a £30Bn funding gap by the end of the 2020, so there is a big driver for government to invest in tools which can help drive efficiencies and effectiveness to close that. The NHS is itself setting up its own Innovation Accelerator to try and make this happen but there will be numerous commercial entities that do so too.
As context for the scale of opportunity, $4.5Bn was invested in the US digital healthcare system last year.
Top 5 opportunities for digital healthcare startups:
- Patient centred care that puts the monitoring of health in the hands of users
- Admin efficiencies through digital
- Improving communication between doctors and NHS organisations to drive efficiency
- More effective data analysis for Research & Development through Machine Learning and Artificial Intelligence
Echo
Echo aims to allow people to manage their own prescriptions through an app and is one of the organisations Local Globe has recently invested in.
The NHS spends about £12Bn on prescriptions each year and up to half of this is not taken as recommended or thrown away. Echo takes prescription instructions and automatically fills in a calendar for you about when you should take it.
