A couple of weeks ago NHS Digital published a policy paper outlining their technology strategy for the foreseeable future. It’s not a tactical piece - it doesn’t really say how to implement policy, it’s more a cri de coeur for a progressive vision for healthtech across the NHS and for that vision to influence healthtech strategy across the UK and the world.
Having that influence is no small ambition, yet neither is it insurmountable. The NHS is the world’s largest healthcare institution. If it gets its approach to technology right, despite all the moving parts, political wranglings and assorted pressures, there’s no reason that any other health-focussed organisation should be unable to do so. Indeed, if the people steering it do get it right, the NHS' roadmap and philosophy should become a guiding star for anyone else who delivers services that have a technical aspect.
The good news for the NHS, anyone who uses it (so perhaps the 60 million UK residents they serve) and those of us who understand how to create effective services is that this policy document shows an enlightened approach is being taken.
The NHS wants four guiding principles to underpin everything it does:
This is the foundation of the whole piece. Focus on the user first: what do they need? what do they want to use? how do they want to use it? why do they want to use it? Ask these questions before putting any service in place. Keep asking these questions while the service is live: test, learn, iterate and repeat. Beginning with, and repeatedly revisiting, user need is key to the development of any successful service.
To Edo - expert practitioners who have long been developing healthcare services with a technical aspect - this is second nature. It’s also second nature for many of the team working within and for government, but it can’t be reiterated enough. Still too many decisions (as the policy paper acknowledges) are made technology first, or assumption first, or based on organisational desire. Focusing on those aspects leads to poor decisions, to failure, and ultimately to bad investments. A continuous focus on user need gives investments the best chance of success.
Edo always works with our clients to define and deliver user centred services. One such is a community support service about which 99% of its members say that “it offers vital support”. We built this the right way - from user need, up.
Privacy and security
The NHS holds some of our most personal data and our data must be secure and remain private. 77% of us trust the NHS to handle data the right way1 while 73% of us would allow it to use our data to improve healthcare services2. It’s vital that all healthcare services and associated healthtech maintains trust, or users won’t use them. So, especially in healthtech, trust is a crucial factor when delivering against user need.
With one of our big data partners and a charity healthcare client Edo is beginning to aid early diagnosis of conditions that are so increasingly prevalent and so expensive to treat that if left unchecked they could become an existential threat for the NHS. The outcome of our research in this area showed the need to pilot a triage service with a digital application, which we’re currently implementing. We’re also, with another client, considering the need for video counselling. The layers of data protection, privacy and security for each of these services are premium, because as with all healthtech services, it’s vital that data is completely secure and treated with the utmost care.
Interoperability and openness
To be able to iterate and implement changes in services according to user feedback and need, the service and the technology that supports it must be flexible. The paper states the NHS needs “modular IT systems, where any module can be easily switched out” this will allow changes to be made to services without having to tear down the whole infrastructure - an expensive and time consuming endeavour.
Service change, especially technical service change is best effected incrementally. Modular shifts (whether you’re moving website platforms, or developing and integrating donation platforms, CRMs, CMSs - any piece of tech infrastructure) are best done piecemeal, rather than by overhauling an entire architecture at once. Interoperability is key to successful technology. Sweeping change is expensive and risky. Bringing in technology piece by piece - testing, learning, iterating and moving to the next thing when user need is met is the way successful services are built.
The 60 million users of NHS services are not all the same. They don’t have the same needs, the same abilities, feelings or behaviours. The policy paper states that all services that use technology must be usable by as many people who require them. To enable this they have to be built with accessibility in mind from the ground up.
Following WCAG guidelines, running accessibility audits, building accessible platforms and creating accessible content are all well understood - particularly among those of us who build and design healthcare services as a matter of course. What’s really key here though, is understanding the needs of users who use and access services with assistive technologies or who require very clear language, specific levels of contrast, need translation or assistance to use healthtech and the services it supports.
Working with our diverse client base, Edo has run research with patients, service users and their support networks - with empathy and sensitivity where required - in order to really understand every kind of user that may try to access services and to ensure that we’re designing for them. Baking those considerations into the heart of services, ensuring that inclusion is key to our understanding of user need means we build services that everyone uses - successful services.
Why is this good?
It does feel like I’ve written an article saying the “NHS has finally caught up” and/or “look, Edo has been doing this stuff for years and aren’t we clever?” Cynically, both of these things are true, but those truths don’t detract from the real reason that this is good - which is this:
If the world’s largest healthcare institution, with all its frailty, can approach technology and service delivery in the right way, can drive innovation in patient care, can ease the burden on its creaking bones and most importantly - can use these techniques to continue to deliver positive patient outcomes now and throughout the 21st century, that’s really something to celebrate isn’t it?