The healthcare sector is no different to many others where the march of digital disruption is concerned. The fact that we live in an increasingly connected world is apparent to all and connectivity brings both challenges and opportunities in healthcare. NHS Blood and Transplant (NHSBT) is at the forefront of the digital advance into healthcare in the United Kingdom, leading the way in providing applications that connect blood donors and doctors to its core operations.
Through the provision of cutting edge digital services, NHSBT has improved the experience of both donors and doctors, created an online community of promoters of blood and organ donation, increased its efficiency and reduced clinical risk. It has not all been easy, however.
Two of NHS Blood and Transplant’s digital services are the online Blood Donor Portal and the mobile Electronic Offering System (EOS) for transplant organs. This article explains both services before considering some of the challenges experienced and lessons learned from their development, as well as NHSBT’s future plans to extend the reach of its digital ambitions.
The Blood Donor Portal.
The Blood Donor Portal
NHSBT launched the Blood Donor Portal in November 2013 as a secure online donor registration service along with downloadable apps for Android, Windows, and Apple smartphone and tablet devices. The service allows blood donors to search for, book and manage donation appointments based upon their location and donation preferences.
It also allows them to register using their Facebook or Twitter accounts, and to share their experience of donation directly with their friends and contacts. More recently, the service has been extended to allow donors to provide immediate feedback on their donation experience, allowing NHSBT to continue to improve the overall session experience.
Since the launch of the booking service there have been over 3 million transactions, over 50% of appointments booked through the portal outside the session and over 1.5 million appointments made. At the end of January 2016, the one-millionth donor registered to use this service. The move from donors making provisional bookings online that often required a call back or further email correspondence to secure a booking, to a modern, personally managed service is time-saving and easier for donors and regular feedback from donors has been used to inform the design of the service.
The service is effective in other ways too. There has been a 3% increase in attendance from donors at sessions that book via the online service compared to those who book by telephone. While financial savings were not the driver for the programme, NHSBT has saved £1.2 million as a result of the portal thanks to a reduction in transactions through its contact centre and a reduction in print costs with donors viewing their welcome pack online and managing their own records.
The Electronic Offering System: EOS Mobile.
The Electronic Offering System: EOS Mobile
Another of NHSBT’s digital services is the Electronic Offering System (EOS) for transplant organs and, more specifically, the EOS Mobile solution. The EOS system itself was introduced in 2009 to digitise the core donor data set, collected by Specialist Nurses for Organ Donation when characterising a potential organ donor in the Intensive Care Unit. This was a 14-page form that included a substantial past medical history of the potential donor and the tests carried out since the donor had been admitted to intensive care. The information contained on the form is transmitted electronically to transplant centres to allow them to consider whether any of the donor organs may be suitable for a patient on their transplant waiting list.
The original EOS application provided all of this information electronically, including patient identifiable data and, given its size, was only accessible using a laptop or desktop computer. In order to protect the identifiable data, multiple logins were required to authenticate the transplant centre users. As a result, the user experience was poor and only 50% of organ offers were viewed electronically. It was common for transplant centre staff to request that the information was provided verbally over the telephone rather than logging in to the system, with a significant risk that information was misheard or transcribed incorrectly.
The EOS Mobile app provided a simplified view of the data based upon research into those data items that were critical for decision-making and the actual use of the information. It became clear very quickly that much of the patient identifiable data was not required when considering an organ offer. The research also identified those devices most likely to be used – tablets and mobile phones – and a simple, accordion-style user interface was developed to display the critical information quickly on those devices.
Within two months of the EOS Mobile system being launched the percentage of organ offers viewed electronically jumped from 50% to 99%. Clinicians were confident in the information being provided to them and, by removing the verbal communication and transcription of complex clinical information, clinical risk was reduced. In terms of efficiency, the time taken to review organ offers was halved on average. To quote one transplant surgeon, “EOS Mobile revolutionised the way we take organ offers”.
Challenges and learnings
The Blood Donor Portal and EOS Mobile are just two of the digital innovations that NHSBT are delivering to connect donors and doctors to its core operational services. They have each had a significant impact on the way NHSBT relates to the public and transplant clinicians respectively. In the delivery of each solution, however, there have been learnings along the way and it would be a mistake to think that it is possible to deliver innovations of this kind and get everything right first time.
When considering any digital service, care needs to be given to the volume, flow and security of information. In NHSBT’s early iterations of both of these digital services, not enough thought was given to the volume of information. The early versions of EOS provided 14 pages of data to transplant surgeons with little to distinguish the critical information needed to make a decision from background information, which may inform future treatment.
In the case of the donor portal, donor feedback was that the early versions of the portal provided too many donation session options, not all of which had available appointments. This resulted in confusion and frustration on the part of the donors as well as creating an additional burden on the back office systems required to offer up the session data. Later versions of both services provided a more focused set of data better suited to the needs of the users.
Information flow is an important consideration too. Care is required in understanding where the information is coming from and where it is going. This informs both the technical infrastructure needed to provide the digital services and the governance and security necessary to protect the information. Where is the information coming from and where is it going? Who is it coming from and to whom is it going? Do we have consent to provide the information in this way?
Is the information appropriately protected? And do the recipients of the information have sufficient context, knowledge and ability to use the information in an actionable way? All of these questions are more complex to answer than they first appear but unless the last is true – that the information is actionable – then the provision of the connected or digital service is unlikely to be effective.
Digital or connected services inevitably increase the load on existing operational systems and processes. Unless the operational systems – in the broad sense of the collection of activities, processes, people and tools that make up the system – are made ready, the introduction of a digital service can be counterproductive.
In allowing appointments to be booked via the donor portal, NHSBT opened up its appointment database to the public sometimes in advance of those same appointments being made available to regular donors for repeat bookings. This meant that a number of sessions became fully booked before the regular donors could arrange an appointment. Changes had to be made over time to ‘feed’ the online appointments booking system alongside other mechanisms for making appointments in order to ensure that all donors, new and regular, had a fair opportunity to book the appointment that worked for them.
NHSBT’s digital transformation has progressed at a faster pace than the transformation of its underlying technologies – such is the nature of the digital world. Many of the information sources required to serve the portal and EOS Mobile are the same sources that are required for core operational processes. In the early phases of both systems, the back office systems were not sufficiently protected from peaks in demand from the digital service – resulting in operational processes being reduced to meet the digital demand.
Donor take-up and autonomy
One of the most pertinent lessons learned by NHSBT was simply that service take-up is unpredictable and that the users of these services will use them as they choose, not necessarily as anticipated. The EOS Mobile application went from 50% usage to 99% usage in just two months. Donors using the donor portal exceeded predictions from the very start and within six months there were as many users as had been expected in the whole of the first 12 months. The ability and readiness of staff and the public to use digital services should not be underestimated.
By making the donor portal link with Facebook and Twitter for registration purposes, a link was established that could also be used to promote blood donation to friends and contacts. In doing so, NHSBT had to accept a degree of donor autonomy – that the message could not always be managed – and that donors would share their experiences as they saw fit. In practice, donors’ sharing their experience has been overwhelmingly positive.
Learn from user feedback
The rapid take-up of these services was not fully anticipated but was very welcome. Their ongoing use, however, has been achieved because clear service management and service support teams were put in place to respond to user feedback. A number of improvements to each service have been made throughout their lives and the user interface for the donor portal was recently completely redesigned to provide easier access to information and transactions. Each of these improvements was made following engagement with the service users to understand and better meet their needs.
User feedback was also important in the way that NHSBT designs its operational processes. In traditional ways of operating the organisation would find an issue that needs resolving, gather staff together to define a solution and then apply a digital solution. In terms of the portal, the process started in the same way but because of the success of the solution, NHSBT was able to secure user feedback and then use that feedback to reengineer the back office business processes to meet the demands on the portal more effectively. Reengineering of appointment grids, breaking down of donor panels into specific blood groups, development of additional paperless solutions are other initiatives that have therefore come out of the donor portal feedback. This is reengineering in reverse.
While these learnings demonstrate the need for ongoing improvement and that it is difficult, if not impossible, to get everything right first time, the nature of digital services is that when they are designed well, they are designed for rapid change and improvement. A digital service designed to be static and never improve is unlikely to be useful for very long as both the technology available and the business environment in which they operate is changing rapidly. Taking the lead from the UK’s Government Digital Service, NHSBT has adopted a service approach, designing services that are user-centred with agile and iterative methods deployed to improve them.
NHS Blood and Transplant has ambitious plans to extend its digital service offerings. The IT analyst firm Forrester have expressed the path towards becoming a digital business as consisting of two imperatives – ‘digital customer experience’ and ‘digital operational excellence’ (Forrester, The Future of Business is Digital, March 2014). NHSBT’s existing digital services have focused on the former – providing a first class digital customer experience.
Moving forward, NHSBT is reframing its digital strategy to be even more comprehensive, reflecting on the different perspectives or lenses through which the organisation may be viewed – a healthcare organisation; a customer service organisation; a supply chain organisation; an information organisation; and a ‘matching’ organisation. In each case, NHSBT is considering exemplars in these areas to inform its future digital strategy, whether that is the Internet of Things and wearables in the healthcare space or ‘big data’ and the ‘über’ phenomenon in the case of information and matching algorithms.
The challenge is not simply to connect doctors and donors but to move on to connect to the wider healthcare system and other ecosystems – retail, manufacturing, the Internet of Things – in order to provide a truly end to end digital transformation.
About NHS Blood and Transplant
We stand for hope. We stand for life. We stand for helping people to do something extraordinary, save and improve the lives of others. As an essential part of the NHS we take pride in playing our part to make the most of absolutely every donation – from blood and organs to tissues and stem cells.
The donors who make our work possible do so selflessly, giving life and changing life for the better. It is because of them, and the people who need their life-saving and life-enhancing donations, that we strive to be the best in all we do.
NHS Blood and Transplant (NHSBT) is a joint England and Wales Special Health Authority. Its remit includes the provision of a reliable, efficient supply of blood and associated services to the NHS in England and North Wales. It is also the organ donor organisation for the UK and is responsible for matching and allocating donated organs.
NHSBT collects 1.7 million units of blood each year from over 23,000 blood donation sessions in more than 3000 venues. NHSBT facilitates over 4000 organ transplants and 12,000 tissue implants each year.