User research is a crucial part of digital service design. It embeds user needs into the things we build – ensuring they will be useful once released into the real world.

My name is Chris Marshall and I’m a User Research Manager in the HSCIC. I’m part of the NHS Citizen Identity Project, which is exploring online identity in the health and care system. So you know who’s who, Shaun Addy is leading the project on behalf of HSCIC and Indi Singh is leading from NHS England.

This blog introduces the project and shares some findings from our discovery user research.

The identity challenge

The NHS can better meet the needs of citizens by allowing them do more things on NHS.UK. This ambition is explained in the National Information Board’s vision for personalised health and care. Increasing access to digital services will give citizens more control over their treatment and care.

To enable citizens to do more on NHS.UK we will need a way of verifying their identity – so we can be sure they ‘are who they say they are’ when they are online.

Exploring user understanding

Our research indicates that identity verification is an abstract concept for most people. This is unsurprising, given that only a small proportion of citizens have fully verified their identity online using a service like GOV.UK Verify.

There is also a lot of general misunderstanding about what identity verification is:

“The NHS can directly identify me – they can use my driver’s licence to prove my identity.  When I go to the hospital they ask for my GP, name, address, date of birth but the GP already has all of my information”  (U17)

The reality is the attributes that the NHS holds about a service user is not enough to verify their online identity.

How are we going to explain this to citizens and provide compelling reasons to go online and verify their identity with the NHS?

Making it real

During our most recent user research sessions we tested an on-screen prototype. We set the citizens a ‘real world’ goal – book a GP appointment – and asked them to use the prototype to try and complete this goal.

We used the prototype to gauge how citizens reacted to the premise of identity verification as part of an online NHS journey. It’s not the thing we’re actually planning to build right now but allowed us to test different ideas and theories.

Fig 1. Prototype identity login/registration screen

Guest blog - CIP - Fig 1 “I haven’t got an account with NHS” (U24)

“I don’t know what that is, GOV.UK” (U25)

“Facebook wouldn’t worry me, it’s just my login details” (U27)

“Do we click create to move it on?” (U28)

“Facebook and things like that, I don’t use them to access the NHS” (U29)

We observed the citizens enter their personal information and click through the screens ‘habitually’. They didn’t pay a lot of attention to a) what they were being asked to enter or b) how their information would be used. This was until they reached a screen that asked them to capture an image of their passport/driver’s license using a webcam or smartphone. At this point they realised the process was more stringent than what they were used to – they were not just setting up another online account.

Fig 2. Prototype document capture screen

Guest blog - CIP - Fig 2We intend to continue testing out our hypotheses using prototypes. It’s remarkable how much insight you can gather from observing people use something.

Members of the GDS Verify and NHS.UK Alpha teams were also present during the research sessions. The GDS Verify team have been conducting user research on Government transactions and identity for a couple of years now. They have tons of knowledge in this area.

The NHS.UK Alpha team have also started exploring where identity may fit into an online appointment booking journey. It’s been great to compare notes and video findings with Martin, Paul, Matt and others.

There’s a lot to try and understand

We know that the overall goals of citizens are driven by their health needs, and to achieve their goals they have to interact (or transact) with health and care services. Identity verification is the enabler that will let them transact with health and care services online.

If citizens are going to verify their identity online with the NHS they need to know the benefits. After all, why should citizens spend time completing a verification process rather than picking-up the phone to book their GP appointment?

To help understand the requirements for any solution we’ve generated an initial list of needs that people may have. At a high level, we’ve learnt that citizens need:

  • to know the benefits of verifying their identity
  • to understand what identity verification is
  • to be able to easily verify their identity
  • to know who will verify their identity
  • to know that identity verification is private and secure
  • to know who has access to their personal information
  • to know how their information will be used
  • to know they are using a NHS or Government service
  • to know about their data protection responsibilities and what they need to do

Some citizens will also need help – not everyone has the access, the digital skills or the ability to verifying their online identity with the NHS.

What else

The team are also exploring technical considerations around risk assessment, privacy and compatibility with existing health and care information systems.

We need to complete further research with citizens, health professionals, clinical administration staff and other groups who are likely to use the thing.

We’re defining the scope of the Alpha project(s) and considering how they will integrate with the NHS.UK Alpha, GOV.UK, NHS England, HSCIC and local initiatives.

As you’ve made it this far you must be a bit interested in our work, so feel free to get in touch if you want to find out more or have something to share.

@CMarshall1984

5 comments

  1. Yeah this is really interesting study. It’s surprising that some users – being so used to using OAuth with Facebook and whatnot – would be OK with using that for something like a healthcare account as well.

    Do you think, ultimately, a GOV.UK Verify account will be what’s used to sign in for NHS services, or does there need to be a separate NHS account?

    Reply
  2. Comment from Chris Marshall

    Yes, during the research we found that younger people (particularly those pre-30/without kids) were more receptive to using Facebook and other social logins to ‘sign in’. They tended to be more comfortable and familiar using social logins across a range of online services. In contrast to the older citizens, they tended to have less experience of the health system and didn’t consider personal health/medical information to be particularly sensitive. However, the majority of citizens we spoke to did have concerns about social logins in an NHS context, and did consider health/medical information to be sensitive.

    At this stage of the research we just wanted to understand how users react to the concept of social logins for health without going into the technical, privacy and legal detail. So it’s been helpful to capture this evidence – it allows us to out work out what to explore next in more detail. The ‘sign in’ / account feature was in itself a concept used in the research for learning, rather than something we are intending to build.

    No decisions have been made yet about what the overall solution will be. We still need to explore where ID verification fits in the patient journey and what it could enable the patient to do. Any solution we consider must be focussed on meeting clearly defined user needs.

    Reply
  3. I think this is incredibly important to get right and I think the GOV.UK Verify solution is near-perfect. I use the Digidentity version – it’s quick, simple, reassuringly secure, easy to get back my (regularly) lost/forgotten username/password. NHS.UK – just copy GOV.UK and get on with it!

    Personally, I’d not trust a Facebook login not to end up with surfacing adverts on my FB newsfeed for pile cream and viagra.

    Reply
  4. Comment from John Gilmore

    You do realise it is still pretty easy to set up “sock puppet” Facebook accounts?

    Anything which allows the use of a Facebook log in is not that good at verification.

    Reply
  5. Comment from Allan Auty

    I currently use Patient Access to book an appointment with my doctor, see my medical record and request repeat prescriptions. If Patient Access is deemed secure enough for that, what is wrong with using it for everything else? I have also used GovUK Verify and found it over-complicated and would assess that over 50% of people who try to register with it will give up. People who are setting up big computer systems need to look at the real world and not some bubble inhabited by theoreticians and geeks.

    Reply

Leave a comment