Matt wrote a few weeks ago about the areas we’re looking at in alpha, and high on the list was booking. We’ve spent a few weeks looking at this, and I thought I’d write up some of our thoughts on this.

Why booking

Obviously one of the common areas across health is the act of booking an appointment. Whether it’s with a GP, a nurse or another clinician, bookings are largely handled through non-digital channels.

We focused initially on booking appointments at GP practices. We started talking to practice managers, GPs, and receptionists, as well as patients. This gave us a feel for how the booking process works from a patient’s point of view, and also from the point of view of the people who are taking the bookings.

We started sketching prototypes and mapping the journey, and pretty quickly came up with some ideas as to the sort of services that would be useful to build.

A consistent way of booking

The demo is here, if you want to try it out. Before you click around, there are two important caveats.

First, the alpha was about challenging some of our assumptions about how healthcare works. Some of the findings seem obvious, but it’s really valuable to get this from professionals all over the system.

Secondly, we’re trying to build some prototypes to illustrate a vision, not trying to solve booking right now. If we were, we’d be doing supplier engagement and much more in-depth research. We’re aware that some of our prototypes don’t work in the same way as current GP booking systems operate. That is because we are deliberately imagining what could be possible in future.

Some thoughts then;

  • We’re firmly focused on the patient-facing system, rather than the back office system – we’re not trying to get into competing with existing GP IT suppliers. We believe there is value in patients having a consistent experience regardless of where they live, or what kind of healthcare provider they’re booking with. A consistent experience would be a good foundation to build on too.
  • Under the hood it should integrate with existing systems – (or, as our colleagues over the river might say, Do The Hard Work To Make It Simple) we need something that integrates with booking system suppliers, built using the kind of standards introduced by things like GPSOC.
  • Scheduling at surgeries is a hugely complex area – partly through design and partly through accident, there are a huge number of ways that surgeries schedule activity. That’s another reason that a full end-to-end booking platform wouldn’t be the right direction for the project.
  • A big list of open slots might not be helpful – our idea is that people might appreciate some ‘guided choice’ when booking, rather than just being shown a full list of appointments. We wanted to build something that acts a little bit like the receptionist does when you go in face to face or on the phone, so you have the potential to tailor what you want (‘I’d prefer an evening appointment/an early morning appointment/I’d really just see a female doctor’, etc) As always, this needs to be tested with users. Another idea was that the booking service can remember a user’s booking preferences, so if a user has a long-standing medical condition, and has regular telephone appointments, the booking service can remember this previous behaviour, and start by showing the user the soonest telephone appointment with their regular doctor.

Available Appointments Screen

What’s next?

We’re taking the booking prototype in for another round of user research this week, but after that we’re moving on to focus on a different area. We’re happy with the kind of vision it demonstrates for the Alpha, and it provides a bit of a taster of what could be done in this area.

If you have any thoughts while using the demo, please let us know in the comments below, or by emailing us.

17 comments

  1. Comment from Jon Hilton

    Does the first available appointment preferentially go to GPs over other healthcare professionals?

    Frequently GP practices will have medical or nursing students on placement, maybe the point of booking an appointment would be a good time to ask if a patient is happy to have a student present during their consultation.

    Reply
    • Comment from Joe McGrath

      Thanks Jon

      In our prototype we looked at GP booking in particular, so we showed the first available appointment as being with a GP.

      Depending on the type of appointment you were booking, the user might also see the first available appointment with a Nurse, or other healthcare professional.

      Regarding students – good idea. This could be tested with both patients and clinicians as and when booking is tackled in more detail.

      Reply
  2. Comment from Paul T

    As a UI designer for a medical software company supplying NHS trusts, I’m interested in the work you’re doing. Much of my work over the last 6 months has been re-thinking and skinning the display of patient identification elements and clinical input controls towards CUI (Common User Interface) compliance by the December 2015 deadline. (See: http://systems.hscic.gov.uk/data/cui ).

    Whilst there is some very good reasoning behind much of the CUI standard, there are items which seem backward from a UI perspective and yet are mandatory for compliance (so frustrating).

    And yet, I note that your current demo doesn’t yet follow the CUI standard for input controls. (I appreciate it is only a demo), but do wonder if you be following the HSCIC standards in the future?

    Paul

    Reply
    • Comment from Joe McGrath

      Thanks for the comment Paul

      We’re aware of the CUI standards. As part of the Alpha project we will also look at the many standards that exist around digital in health care. We’ll potentially propose consolidation of some of these standards, so they work for users and for the people building services.

      Lastly, it *may* be that we need different standards around public-facing services, that we have around clinical-facing services.

      Reply
  3. Comment from Paul T

    The browser most used within NHS environments continues to be IE8 (XP embedded), with little support for web standards. Something to consider when designing cross device/browser. Public facing is fine with wide adoption of modern browsers, but behind the GP and Hospital Doors lies an archaic inflexible beast that resists change!

    Reply
  4. Comment from Bob F

    After the 12 weeks stint, what will happen afterwards are you looking at developing it further and engaging with third party suppliers to support what you are doing or have you already approached them to see if they are willing to adapt their product for your system.

    Reply
    • Comment from Joe McGrath

      Hi Bob

      Right now this is just an Alpha. We’re building prototypes based on a range of ideas to help illustrate a vision. At the end of the twelve weeks we’ll be sharing this vision more broadly, and seeking feedback and ideas.

      We’re not trying to solve booking right now. This is one example a user-needs-led service. If a booking service is taken further in future, the team leading on that would engage with third party suppliers.

      Reply
  5. Comment from Chris Frith

    It would be good to see the present offerings from GP suppliers for comparison. I agree the clinicians photos and the potential choices for reminders are useful additions. One big loss is no box for reason for appointment which is necessary in open appointments to improve efficiency in the consultation and to start patients thinking about what their concerns and/or needs are ie enabling patient empowerment.

    Reply
    • Comment from Joe McGrath

      Thanks Chris

      Yes – we’ve explored the feature around ‘reason for appointment’ in some of our other prototyping. It wasn’t in this prototype as we weren’t aiming to test that particular idea. We’ve had some good feedback on this feature from both patients and clinicians, so it hasn’t been lost as such.

      Reply
  6. Joe, I have changed my position dramatically over the last decade regarding patients being able to directly book appointments with clinical staff in all settings. What at first seemed such a straightforward ‘digital’ transaction to make available, is far from the case when you get under the surface and think it through. My view now is that (other than some particular cases) directly accessible booking is grossly inefficient and quite inequitable too.

    You describe the alpha stage as about ‘challenging some of the assumptions about how healthcare works’. I’d really challenge you and your team to address this question first. Is it actually a good think to allow patients / public to directly book clinician time?

    Glen Griffiths – Head of Tecnology, GP Access Ltd

    Reply
    • Comment from Joe McGrath

      Thanks for your comment Glen. Sorry for the delay in responding.

      I think that booking itself is just part of the puzzle. We are looking at how we can better connect members of the public with the most suitable service for them. The act of booking is just part of that. We’re trying to design digital solutions that complement, rather than replace, face-to-face contact with healthcare professionals.

      There’s also a lot of different types of appointment. Some are to understand a new symptom, whereas others might be to get a routine task performed, like a blood test. These different types of appointment perhaps shouldn’t all be dealt with in the same way.

      We’ve written some more of our thinking around booking here
      http://digital.nhs.uk/booking-is-critical-for-transforming-healthcare

      The idea of interacting with clinicians asynchronously is also really interesting, and perhaps something we’ll explore.

      Reply
  7. Comment from Gavin Jamie

    I notice that you make no attempt to authenticate the patient. Potentially any patient could book with any doctors or nurse. There are a few cases where this is not appropriate although this is more fringe stuff and outright fraud cases should be fairly slim.
    There is more of an issue of pratices being able to see who is booked with them. Are you hoping to match purely on name and dob (and will you not book if there is not a match on the system?)
    Is there a limit to the number of appointments you can book or is a “Denial of Service”type attack feasible?

    Reply
    • Maybe using a patients NHS number to identify them? Not sure about the logistics of this.

      Reply
    • Comment from Joe McGrath

      Thanks for the comment Gavin. For the purposes of this early prototype we were just testing some concepts, so we deliberately left the sign-in process fairly vague.

      We’d be planning to only allow people to book GP appointments if they are registered with that GP Practice. As and when we build this as a real working system we’ll work with GPs and GP system providers to resolve issues such as malicious booking of appointments.

      There is another team looking in much greater detail at the idea of Identity in Health and Care.

      Reply

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