The potential for a new digital front door for patients is generating excitement. What could this mean for changing how people engage with services, and how will it differ to digital tools today? NHS organisations engaged in discussion at Orion Health’s Scotland Customer Conference.

“A digital front door is the next big leap forward.” These were words from Graham Gault, eHealth director at NHS Dumfries and Galloway, speaking from the floor of the Orion Health Scotland Customer Conference 2023 in June.

“Ten years ago, clinical portals were the way healthcare was going to leap forward in terms of capability,” he added.

But now, the opportunity is shifting to make better use of consolidated datasets and care records, and to focus on how patients can use digital technology to better engage both services, and with their own health.

What a digital front door might look like

Pledges around introducing a digital front door for citizens have already been reflected at a national level in Scotland’s Digital Health and Care Strategy. Commitments have been made to develop this as a “way-in” to services, both digital and physical, across different settings.

E-health directors told the Orion Health conference that they now want to understand from suppliers what a digital front door could look like in practice. Questions were raised at the event on how such a front door would work on the ground, and how to build an effective business case for a digital front door that could convince those who make funding decisions, especially at a time when NHS funds are stretched.

Some learnings can already be taken from examples around the world, the conference heard. Chris Hobson, chief medical officer for Orion Health, told delegates about initiatives in different parts of the world to bring together information from previously siloed settings, where effective patient access has also proven key.

For example, in one geography in Canada, patients have been provided with access to an effective digital front door. Built using Orion Health’s Virtuoso patient engagement platform, this has combined a public-facing website with a dedicated call centre, to enable people to transition seamlessly from seeking advice, to engaging with the health service.

And importantly, this patient facing technology is supported by Orion Health’s shared care records platform, so everybody involved has access to previously siloed data and appropriate access to an individual’s medical history. Such integration means that patients can find information, access booking and other tools, and have necessary action taken, without having to leave the platform. Further developments being considered include enabling patients to fill in questionnaires, provide feedback on their care, and join remote monitoring programmes.

Work is now underway to measure the value of such digital front door initiatives – including metrics around A&E attendance.

But ultimately, such technology deployed correctly is about achieving much greater patient engagement, which has been shown to both improve outcomes and lower costs, Hobson told the event.

He asked delegates: “What do we mean by patient centric care and outcomes that matter to patients?
“The kind of things clinicians normally consider include ‘did we replace the hip joint successfully?’. When you talk to the patient, their measure of value is ‘can I get back to work?’.”

“Patient centred care is about having the patient as part of the team, with the patient contributing to decisions,” he added. “It is about an active discussion. It isn’t doing everything the patient wants. It isn’t about throwing things at the patient and saying, ‘you decide.’.

“Involving the patient is the right thing to do. It is associated with better outcomes. And this can only be achieved through better use of technology.”

Moving beyond the limits of patient facing tools today

An effective digital front door should also not end at information provision, the event heard. “Patient engagement is a contact sport, it is really difficult,” said Mark Hindle, vice president for UK & Ireland at Orion Health.

“And if you think it is about the digital front door, you are totally missing the point,” he added. “It starts before the digital front door, and it ends after.”

Digital front doors also require effective service transformation and new ways “to work differently together” around the patient, delegates heard.

Hindle live tested a number of different symptom checker apps currently available to NHS patients. Each scenario explored showed a lengthy and generic process, that ultimately led to the app being unable to provide patients with either the information or the service they required.

“On the things it can’t help you with, there is no signpost to where else I can go,” he said, questioning if the apps had been tested with users at the point of being prompted to answer if he was over five years old.

“The computer says no,” he told delegates. “This is not a digital front door,” he said. “I’m not prompted to call my GP. It doesn’t try to find out who my GP is.”

The objective should be to provide patients with what they need to be active in their care, to stay well in the community, or to improve access to and to navigate services when they are needed, the conference was told.

It was also an opportunity to make far greater use of new datasets by connecting patients and their clinicians with those datasets – “shared records brought to life.”.

“We need to build something that is navigable as a person, and road test it with real people,” said Hindle. “Unless you can go through it, it is not a digital front door.”