Signposting and evidence | Weeknotes S01E01
2–10 Jan 2019
Since coming back to work on 2 Jan, I have been mostly getting my head around new things: the evidence standards framework for digital health technologies (more on this later in this post) and the NHS long-term plan (more on this next week).
Signposting to urgent care services
The very first thing I did, though, was demonstrate some new concepts to a large group of stakeholders at the 111 Online team’s show and tell. At 10am on Wednesday 2 Jan — my first day in the office after a solid period of relaxing, eating and drinking too much and generally forgetting what it is I do for a living.
The back-story for these concepts is pretty interesting but in summary:
- There are 59 conditions or symptoms on the NHS website which signpost people towards urgent care services like walk-in centres, minor injuries units and urgent GP appointments. (For clarity: A&E departments are meant for life-threatening emergencies, such as loss of consciousness or stroke. Urgent care services are for things like minor head injuries or feverish illness.)
- There’s not a lot of consistency in our signposting at the moment. That’s not a huge problem because a user is unlikely to visit the hand pain and urinary tract infection pages in one session. But there’s also no good reason for there to be such variation.
- More importantly, some of our existing signposting is not as practicable as it could be. We sometimes say ‘Ask for an urgent GP appointment’ but we don’t offer an alternative in case you can’t get an appointment right now. We sometimes say ‘Go to a minor injuries unit or A&E’ which means we’re dumping decisions onto users at a time when they need clarity from us.
- The urgent care system is going through some pretty big changes at the moment: the current, confusing mix of services is being standardised and rebranded as ‘urgent treatment centres’; the online version of 111 is now available for everyone in England; and there is a goal to reduce the nuber of people who walk in to urgent care services and make access through NHS 111 the default option.
- Because of all this, we’ve been reconsidering how we signpost people from the NHS website to urgent care services.
We’re using something called the ‘urgent care card’, which is an existing pattern. On this page it’s the red box that says ‘Go to a minor injuries unit or A&E if’: https://www.nhs.uk/conditions/hand-pain/
The (not so) big difference with our new care cards is that they will all direct people towards NHS 111 in the first instance. And if users prefer not to use 111 we offer other ways to get help like making an urgent GP appointment or finding your nearest urgent treatment centre. You can see the prototype in action here: https://nhsuk-urgent-care-prototypes-main.azurewebsites.net/conditions/hand-pain-details
It tests well in labs but we need to put this new pattern in front of thousands of people to understand how it works in the real world. We start rolling this out in the next week or two across a small number of conditions. The new messaging is going to be seen by about 2 million people in the first month so we should get a good idea of whether it’s working pretty quickly.
Evidence for effective technology
We expect the care we receive from healthcare professionals to be evidence-based. That fact has been established for decades and there is an organisation called NICE which reviews evidence and publishes clinical guidelines for everything from diagnosing and managing Parkinson’s to care planning for older people with social care needs.
Drugs and medical medical technologies all have to produce evidence of their effectiveness and value for money before they can be used in standard NHS care. Now, NICE has published a draft evidence standards framework for digital health technologies — apps, websites and software which allow things like 2-way communication between clinicians and patients, monitoring of patients’ health, diagnosis and preventative behaviour change.
The new framework aims to make it clear what evidence commissioners should look for when commissioning a digital health technology and what evidence the people building that technology should provide. It’s by no means a finished product — for example, the definition of what is and isn’t a digital health technology is both very broad and a little unclear — but I like what I’m seeing so far. I’m also interested to see how it will work alongside other emerging standards and guidelines like the NHS digital service manual and the code of conduct for data-driven health and care technology.
Part of a product manager’s role is to understand and pursue value, and this new framework should help us do just that. Standards help us in two ways: making it easier to do the right thing and making it harder to do the wrong thing. When these evidence standards are finalised we will know what evidence we have to provide and how to provide it, and it will be easier to say ‘no’ to things for which the evidence is lacking.
This week’s cultural highlight
I really like puzzle games like Lemmings, Portal or Spacechem. And Time Turner is a really great puzzle game that had me scratching my head during several bus journeys. Android only: https://play.google.com/store/apps/details?id=com.OnePixelDevelopers.TimeTurner&hl=en
