Where’s My Blood Test? prototype

Can we reduce calls to GP receptions by allowing patients to check the status of their diagnostic tests? We explored how we might make tracking the progress of GP blood tests as easy for patients as tracking the progress of their parcel, pizza or taxi. By providing better, real-time information to patients, we could save GP staff time to the value of £15.4m per year.

What was the problem?

The initial problem area we were exploring came from some user research with a GP practice administrator. They realised that patients can’t see how busy a GP surgery is, so they don’t know when they can expect to receive a reply to an enquiry or request.

After carrying out some initial user research, we refined the problem to explore the perception that sometimes GP practices can appear to be a “black box” – when waiting for repeat prescriptions, referrals, e-consult replies or pathology test results there is no transparency or visibility of progress to patients. A request goes in, but then nothing until the response pops out the other end.

This results in frustration and worry for patients, and increased burden to staff in handling “status update” requests and phone calls.

Although we couldn’t find any national statistics available about reasons for contacting GPs, through desk research and user research with patients and surgeries, we identified that enquires about the progress of pathology test results was one of the most common reasons for patients to contact GP receptions and had significant potential for improvement.

Responsibility for chasing results is often left with patients – they are often instructed “if you don’t hear from us in 10 days, then everything is fine”. However, this “confirmation by absence” leaves doubt in patients’ minds whether everything is fine, or whether the test has gone missing, or a phone call has been missed – resulting in them phoning up their GP surgery anyway.

User research interview with Patient - female, age 32

People’s expectations of transparency and self-service from apps and websites has shifted dramatically in recent years – they are used to tracking the progress of their parcel, pizza or taxi in real-time.

We decided to explore how might we reduce the pressure on GP receptions by allowing patients to self-check the status of their diagnostic tests.

What could be the benefit of improving this?

• The tests ordered most frequently by GPs are blood tests, followed by x-rays and ultrasounds
• Over 100 million blood tests are ordered by GPs in England every year
• Our user research gave us examples where up to six separate phone contacts were required between patient and surgery as a result of one blood test. Uncertainty, and repeated contacts, create additional anxiety for patients, and additional burden for staff
• If we could generate one less phone call to reception for just a quarter of these blood tests, it could free up staff time worth £15.4 million per year
• It would also give patients a better experience, and more control over their own health

Our hypothesis

What did we do?

• Carried out user research with patients
• Engaged with clinicians
• Created a clickable prototype of how real-time status updates could be displayed in the NHS App for patient awaiting blood tests. This had a visual representation of their progress, and an estimate of timescales for next steps
• We used this to carry our further user research with patients and iterate the prototype design
• Researched feasibility to implement nationally

What did we learn?

• User research told us that knowing what was going on with their test, including the current status, timeline and estimated dates would help some participants work out if and when they needed to speak to their GP.
• Knowing the blood test’s progress is not the same as being told the result. This is a step in the journey which may often need interpretation, context and counselling from a clinician.
• Some patients’ worry may increase if they know a test result is back at the surgery, but the GP has not reviewed and released it for them to view.
• Some patients with access to GP records through the NHS App can see historic test results already, although this is not yet universal.
• There is currently no national technical means to track samples through labs - only “sent” and “received” via NPEX. There are only a small number of pathology lab software suppliers in the market, and labs currently operate as a “black box” as far as GPs are concerned. Until that changes, status updates might be limited to higher-level data.

Where next?

• Explore ways in which test tracking could form part of a cohesive user journey with other public-facing digital services which already exist or are in development, for example:
  • After a GP orders a test which requires an appointment such as radiology or phlebotomist, allow the patient to book the appointment online
  • When test results are reviewed and released by the GP, receive an in-app notification and view test results as part of your health record within the NHS App
  • If results need discussion with GP, book an appointment or communicate via chat
• Further technical analysis required to understand what would be needed to track samples throughout the whole blood test process
• Further technical feasibility for different pathways (we researched blood tests, but other diagnostic tests, such as ultrasounds, have quite different processes)
• Further user research with staff and patients into UX requirements for scenarios such as:
  • Dealing with multiple tests carried out on one sample, where results may be returned at different times
  • How to best identify and label tests in the interface – for example, should we call them by the date they were taken; what they were testing for; or what was being tested
  • How to differentiate past, present and future tests
  • Supporting users who may have different needs, such as people with chronic conditions that require regular blood tests rather than occasional diagnostics
  • Making sure the needs of people with accessibility requirements are met
  • How to release test results to patients sensitively and clinically safely
  • How much detail people need in the information provided to minimise uncertainty
• Engaging with stakeholders including primary care, national teams, pathology labs and their system suppliers

More information

If you would like to talk to us about this project, you can contact us at england.innovation.lab@nhs.net