How new digital services can effect real change in public health
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Transcript of How new digital services can effect real change in public health
SH:24
How new digital services can effect real change in public health
Service Design in Government 20 March 2015
Introducing SH:24
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!
Local authority income against expenditure 2010/11 to 2019/20
Concept
‣ New online sexual health service, delivered in partnership with the NHS
‣ Free STI test kits, information and advice - 24 hours a day
‣ Holistic, user centred service integrated with specialist sexual health services
Aims
‣ Improve local sexual health ‣ Improve access and experience ‣ Increase productivity/reduce costs
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Monday lunchtimeA straightforward online assessment and my test kit is ordered.
Monday morningI had unprotected sex a few weeks ago and still haven't had an STI test. What should I do?
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FromSH:24
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Tuesday morningThe kit arrives in the post.
Monday eveningI receive a text message notification from SH:24 informing me that my test kit has been dispatched.
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Tuesday eveningI complete the test kit at home.
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At clinic reception I show my text message to the receptionist.
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In the treatment roomI receive a course of antibiotics.
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2 months laterPerhaps I should retest?
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Friday morningMy results! I need treatment for Chlamydia. I need to visit a clinic.
5 minutes laterI text back SH:24 with a question and they promptly send me a reply.
LCOME4
At the post boxI post the kit back to SH:24.
Should I go to the clinic today?
Thank you for your message. We advise you to visit the clinic as soon as you can. From SH:24
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User journey: Step by step
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FromSH:24
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Guy’s and StThomas’ Charity
CICmembers
Provider commissionercommittee
Operatingboard
Advisoryboard
User group
Key stakeholders: A multidisciplinary team
Policy
Users
IGData
CCGs
Primary care
Academia
Pharmacies
Public health
Civil bodies
Innovation
Safeguarding
Core team
C.I.C
CliniciansPublic health professionalsAgile project managersDesigners Developers
Advisory boardPublic health policySexual health charitiesInnovation organisationsPartner health organisationsAcademiaProviders
SH:24 NHS providers
Local authority commissioners
Voluntary sector
Approach
Prototyping with real users Iterative development
Func
tions
Time
EHC
OralContraception
PartnerNotification
Users are integral to the development of the service. By consulting and prototyping with real users we gain a rich understanding of their attitudes, behaviours, needs and wants. This allows us to optimise existing functions and inform new ones.
Early prototypes typically start life as low fidelity paper based mockups before being digitalised.
The iterative nature of the service’s development ensures that risks are minimised and that the user experience is never compromised – developing functions (not features) that users need, want and prefer to use.
The graph above illustrates how prospective additional functions could be layered to evolve the service – driven by user need and demand.
6–8weeks
1 Build
An iterative approach: Agile prototyping
ChlamydiaTreatment
STITesting
2 Test
3 Learn
The Unboxed Way
Agile principles
Lean Startup
Design thinking
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LOGIN
There are 3 levels of staff permissions to access the portal.
Security
Live orders and user messages are reviewed and logged. Safeguarding and risk assessment responses are flagged. Where appropriate, users are officially referred to their local clinic or signposted to other services.
Order review
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STAFF01
Clinic staff communicate with users via text messages and if required by telephone, email, letter or face to face consultations (where required).
Communicationwith user
LabLab communicates test results anonymously to SH:24 via a secure connection.
A unique identifier (UID) is used to avoid identifying users.
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Results
User
ClinicSecure loginStaff securely login on to the SH:24 with 2 factor authentication portal which logs all orders, users, messages and results.Updates are automatically logged on the SH:24 portal.
Interfaces: Lab and clinic relationship
Following review, new and repeat orders are picked, packed and dispatched. Users are informed about the status of their order by text message.
Order dispatch
Automated text messages notify users of their results. Where appropriate, users are officially referred to their local clinic. Reminder text messages are sent to offer helpful advice to users and prompt the return of test kits.
Result notification
Local stakeholders
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Managing orders and results
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!!
Now and next
Launch (soft)
Continued learning
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Vs
Iteratively develop the service
Evaluation: A continuous process
Economicmodelling
Prevalenceof STI
Whole systemchange
Methodology
Impact onvulnerable groups
Access toservices
Assess impact on local sexual health economy Activity rates and adoption Local economic modelling
Efficiencies/resources
Impact on existing servicesProductivity, freeing up of clinical expertise expectationsConversion ratesTest kit return rates
In what circumstances and for which users is SH:24 acceptable?Developing a safeguarding approach and policyEstablishing how to identify those at risk and how they can be supported
Measuring the likelihood of those at risk of infection/unplanned pregnancy to use SH:24 instead of clinics Explore formal and informal routes into SH:24
How does sexual health service provision change across the whole system as a result of SH:24 activity?Whole system economic modelling, on activity and spend across the whole system
Measuring changes in the rates of diagnosed infection locallyBenchmarking against national data
User experienceHow and why do users make the decision to use SH:24 rather than a traditional clinic?Behavioural trends: Influences and consequencesAdoption and conversionRates of STI testing and messagingReturn ratesVisibilityDesirabilityUtility (take-up) of functionsWaiting times in clinics
Randomised controlled trialsEconomic modellingQualitative and observational user experience dataLive and analytical data on SH:24 website usage
