Digital Front Door - just what is it?

Uh oh…have we got yet another industry term that aims to shroud the self-evident in mystery and technobabble to make its purveyors appear insightful!? 

Well maybe, but the term Digital Front Door (DFD) is becoming more frequent parlance so it will do no harm to explore what the definitions and examples out there offer.  The global COVID pandemic has accelerated digital transformation within healthcare, especially within the contexts of patient experience and patient engagement.  In exploring available definitions and examples there is enough overlap to provide us with a useful set of common features as well as some strategy and principles for design.  In doing so a summary aggregate definition might look something like…

A digital, omni-channel experience that is patient-facing, integrated, joined-up (across entire care journey) and transactional, where value can be realised by both patients (better care outcomes) and healthcare providers (efficiencies/savings).

The rest of this article describes the definitions in use, examples of implementation, key considerations when designing a Digital Front Door, and the specific value they can offer patients*. 

* I’m using the term patient to refer to anyone engaging with a healthcare provider to meet a healthcare need - of their own, or for another.

So what defines a Digital Front Door?  Unsurprisingly there are many interpretations.  Here are a few that can help tease out a general description of what a healthcare Digital Front Door might look like.

NHS England, in the Long Term Plan[1], use the term DFD in the context of “building on progress already made on digitising appointments and prescriptions, a digital NHS ‘front door’ through the NHS App will provide advice, check symptoms and connect people with healthcare professionals – including through telephone and video consultations”.

IDC provide a broader description of a DFD[2] as “Use cases, like the digital front door, are gravitating the pull and accelerating the pace that the healthcare universe takes toward a more consumer-friendly, patient-centric paradigm where doctors are still relevant but patients, as relevant, empowered by technology”.

Microsoft have described DFD[3]s as “Comprehensive digital front door projects frequently include multiple digital touchpoints, connect to a wide variety of data sources, and enhance the workflow of many business and clinical processes”.

McKinsey[4] examined new trends in healthcare delivery and noted a “consumer-focused digital front door that provides patients with a seamless digital channel to access their providers, considering what the integrated product will cover beyond what currently exists and integrated with what may have been put in place in response to COVID-19 (for example, e-triage, scheduling virtual visits, virtual clinic visits).”

Avtex[5] use the description “a successful Digital Front Door strategy provides more ease, convenience, and accessibility to patients and members, throughout the entire healthcare journey, at every single touchpoint, from the very first interaction.”.

Finally, GYANT[6] succinctly describe the DFD as “where and how health systems first engage with patients, assess their needs, and dictate how patients receive treatment and experience care.”

Ok, so there are numerous definitions, but can we extract some common elements that apply across geography, healthcare settings and technology? I have found the following to be common underlying principles for a Digital Front Door:

• Patient facing/focused - not much surprise there - a patient digital experience!
• Transactional, e.g. book an appointment, reorder a prescription, patient/provider communication.
• Integrated– to facilitate transactions such as the above.
• Single point of access- to facilitate the concept of a ‘front door’ which is all about easing the navigational demands of users.
• Joined up– across care settings (primary, secondary, tertiary and social) and considerate to the entire patient journey.

A tall order delivering all of that but there are examples where some of the above have been implemented to varying degrees.

In NHS England, the DFD comprises access to the health record, health advice, symptoms, repeat prescriptions, appointment booking, and, more recently, a COVID pass – all through a mobile app. Note: some of the app’s features are also accessible via other channels, e.g. nhs.uk for health information, 111.nhs.uk for checking symptoms.

In Scotland the closest example of a DFD would be NHS24’s NHS Inform. This patient focused online service offers access to health advice, care services as well as a symptom checker/self-help aligned with the call centre channel. NHS Inform (urgent care) combined with the national Primary Care (GP.scot) digital platform provides Scotland with a broad and connected patient experience for healthcare support. 

In Australia the picture is similar to Scotland where healthcare information, symptom checker and service finder are available through an online service called HealthDirect, again, aligned in key areas with non-digital channels.

Similar concepts to NHS Inform and HealthDirect can be seen in European countries such as Denmark[7], Sweden[8] and Norway[9], where in each of these cases the patient also has access to their healthcare data via a national healthcare identity. Canada’s provinces[10] are also adopting similar models where the healthcare system is a mixture of both private/public and single/multi-payer.

Whilst the healthcare model in the USA is a multi-payer/private one, there are also examples of providers offering DFD experiences, for example: Ochsner Health[11] delivered through their Electronic Health Record (EHR) vendor Epic (other global EHR vendors are available!).

The common thread, or rather theme, here is ‘holistic’, i.e. joined-up services delivered digitally that encompass the full patient journey experience.

In thinking about a strategy for the design and realisation of the above it’s worth highlighting some important considerations that have been identified as common across what has either been written or delivered within the DFD context. These include:

• Availability must be 24/7/365.
• End-user experience must be seamless, i.e. a single, uninterrupted engagement regardless of channel.
• Co-designed with users and front-line healthcare providers.
• Automated to deliver efficiencies and scale.
• Joined-up to ensure that full patient journeys are understood and supported, e.g. prevention, pre-care, during care and post care.
• Omni-channel to ensure that engagement is equitable across generations, geography and technology adoption.
• Personalized to meet the wide ranging needs of individual users.
• Measurable to ensure that continuous improvement is built into the very fabric of everything the DFD offers (or doesn’t).
• Agile – iterative and incremental approach (think big but start small).

Finally, an important point that came up many times when people were asked, how the online healthcare experience should be:

“Make it like online shopping/banking” they cried!

And why not…it’s a reasonable thing to ask for. But beware, this will be a more demanding outcome to achieve within the healthcare context. ‘Make it like online shopping’ translates into ‘ease of use’ and ‘simplicity’, which are significantly impacted by ‘familiarity’. Hopefully, however, we are not going to be as familiar with our healthcare service providers as we are with the likes of Amazon or Netflix – they feed our consumer needs and entertain us, they don’t heal us - though some might argue that the arrival of the next series of The Crown (or South Park!?) might offer us certain healing qualities...

The trick here then is to design for users that are occasional and binge-like, i.e. users will mostly only engage with healthcare services when they must and this is often in times of difficulty and stress. This is a tricky audience to work with but there are some excellent examples where this has be done well and there are many good resources to support us – for example; UK’s Gov[12] and NHS Digital’s[13] service manuals.

Consider, how often you buy something online vs how often you require to engage with a healthcare service. This important nuance underlines and highlights the need for digital service design with the people that use, and deliver, healthcare services – easy to say, never more important than now to do.