Digital Prescribing

For NHS, NSS National Services

This project identified where a digital solution could power a simpler and better end-to-end service for prescribing in General Practice in NHS Scotland. I collaborated with two service designers and a team of technologists, researchers, and clinicians at NHS NSS as part of their ongoing Digital Prescribing programme.

We built on existing work to refine how the problem with the current service is framed, and then redesigned outdated steps to organise the service around patient and clinician needs rather than being driven by legacy processes or technology considerations only.

Current service

With a team of two service designers, I reviewed existing data and research on workflows and user groups. We analyzed what NSS had already learnt previously to zoom out and consider the current end-to-end prescribing service as a whole. This allowed us to understand key service steps and people’s roles within this service, and to reframe the problem from a user perspective. Consolidating and summarising pain points from all the existing data revealed a complicated, inconsistent, lengthy, error-prone, and inefficient process for clinicians, patients, and admin staff.

Focusing only on the technological aspects of the programme such as the digital signature and eliminating paper from the process, there was a risk of simply digitising the current state without addressing its issues. This could have accidentally introduced more workload, complications, or opportunities for error. For example, simply digitising the ‘reviewing’ step could see GPs needing several steps to log into a digital system when they currently have all information needed conveniently printed onto the prescriptions they are signing. This also introduces the risk of admin staff accidentally prescribing and signing via a digital system instead of just preparing prescriptions for a GP to sign.

Instead, by zooming out and considering the end-to-end service, we were able to make visible and review all involved service steps and the roles that currently pin up this service. We identified which service steps and key actions are driven not by a clinical or patient need, but happen due to administrative or financial factors or as workarounds. We were then able to redesign those unnecessary steps into a simpler, streamlined proposal that reorganises the service around patient and clinical needs.

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Proposed service

We identified where a digital solution can power such a simpler and better end-to-end service. This involves 5 key features: Submitting prescriptions and their duration once, patient-led pharmacy selection during or after prescribing, notifying patients at key steps of the journey, prescription end reminders for prescribers, and the potential of a future single medication record. We mapped this future service in detail in service maps, storyboards, and a workflow blueprint. Coordinating with the digital architecture workstream at NSS, we also integrated this proposition with the technical solutions identified so far.

Throughout this process, we reviewed our framing of both the current and proposed service with clinicians. We also tested the service proposition with the clinical advisory group during two workshops focusing on its five key features. As well as all outputs and feedback, the guidebook for running the workshop was included in our handovers to enable further testing and iteration.

Workshop Guidebook

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Workshop Output

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Based on feedback from this group, we iterated the service to address concerns and include insights from clinical practice.

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Finally, we gave strategic recommendations for where further user research, design, and testing will be necessary, where a policy decision is needed to give direction, and other considerations for the programme and its delivery.