If we want more things to be in the app – the NHS 10-year plan says we do – then we need to change the relationship the app offers users. This is how the NHS App team talk about their own work. The app is moving from transactional (open the app, do a thing, close the app) to ’relational’, or a ’companion’. For prevention – I think that looks like the app remembers who you are, what you’ve done, what you’re doing now, and helps you do the next thing. Our role is to help this happen in a way that supports prevention services to meet their goals.
There’s a basic but implicit assumption in the app being a companion – fewer of your interactions with the NHS will be with a human. I don’t think that’s inherently bad. But interactions that get mediated by a screen instead of a human have to work for the user. The minimum requirement is clarity.
We’ve been looking at test results a lot. The test results feed in the app shows you test results from your GP health record. But the results appear as they were written by the lab that did the test. If they’re designed at all, they’re designed to be read by a clinician. But now they’re available to people in the app. The human has been removed from the loop. You get to figure out what your 1/4 result for the AUDIT‑C score‑freq drunk 6+units (fem)/8+units (male) means.
The lack of clarity is hard to measure. But I assume it reinforces health inequalities. The people with the least health literacy, and the least time to decode this stuff, are harmed the most.
Over the discovery we’ve been thinking about how we add clarity back where the human has been removed. That looks like taking the incoming content from the GP health record and making it make sense. We have some plans for how that might be possible.
One consideration I think I’ve been avoiding thinking about is what users need beyond clarity. Depending on the result, the app might one day need to offer reassurance or empathy to be a companion. For now, we are trying to keep the human in the loop, and stop the software from undermining that process.
The results feed is a hosepipe we can’t turn off. We can’t stop results arriving, but we can make the content clearer when they do. We think it might be possible to give teams control over what they show the user, and when.