At HTN Now Digital Primary Care we were joined by Thomas Porteus, Founder and CEO at Iatro, for a presentation on creating a highly usable and accessible GP website for patients.
To begin, Thomas said: “Often what strikes me is how little information practices have about how the websites are actually being used.”
He noted that most practices are probably aware of how many patients are coming in through their front door, and added that the majority are good at understanding the demands on reception and on their telephone lines.
“But practices often only see the tip of the iceberg when it comes to online demands,” he said, pointing out that practices are often unaware of some of the barriers that the public can face in using their websites.
Iatro’s experiences indicate that there is a “really big link between how usable the practice website is… and good experiences for patients and for staff.” Thomas added: “It’s not about being complex or fancy – often a really simple website will do much better for you than a huge website.”
He shared some contextual information about Iatro: a team of primary care experts, they build digital solutions with the NHS with a sole focus on primary care. They offer a website design and hosting service called Practice365 and consultancy service OneContact, which helps organisations manage digital demand.
Thomas explained that Iatro place strong focus on ensuring that everyone involved is well-equipped to work within primary care, with each member of the team coming from a primary care background so that they can support patient communication with solid understand of the experiences and language.
NHS guidance and challenges
Thomas highlighted NHS guidance released in September, available to read in full here.
“For the first time ever practices have a really clear checklist to go through and understand whether they are doing the best thing for their patients when it comes to online,” Thomas said.
Thomas picked out some of the top issues that Iatro see practices struggle with:
- Identify the tasks that patients came to the website for and prioritise improving them. “If you don’t understand why and how patients are using the website, there’s nothing you can do to make that better,” Thomas said.
- Decide how to keep website content up-to-date. “It’s far better to have less content that is spot on, than lots of content that’s out-of-date.”
- Use a template that has the NHS ‘look and feel’. Thomas highlighted how the NHS brand is well-recognised by patients.
- Ask suppliers to use NHS design components. “Most local government websites look similar because they follow a standard GDS and the NHS has done the same work and they’ve invested in that,” Thomas said. “They’ve done the work around accessibility, they’ve done the excess of the work around how it works on screen sizes. Picking up that work is really important.”
- Remove all pop-up banners and overlays. “This is about making sure that the websites look and function really well on mobiles… one of the things in the guidance is around removing all the pop-up banners and overlays. Most of the research is showing that [pop-ups] don’t help patients understand and read the information, and patients can get stuck there.”
The digital front door
“The first place to start is understanding if everyone can get through your digital front door,” Thomas said.
Iatro has been running audit programmes for practices, PCNs, federations and ICBs since the organisation began, and often provide them for free. A QR code displayed on the video below at 6:57 provides the opportunity for people to scan their website in order to produce a report on its content and design.
“One of the areas that’s particularly worth diving into is analytics and accessibility,” Thomas said. “Your accessibility score will tell you how well you need the national standard for accessibility, WCAG.”
Thomas presented some stats from the audits that Iatro have undertaken from the last four years. “Just under 50 percent are failing to meet the accessibility standard,” he shared. “It’s important that you work with your supplier to address those.”
Editing content can influence accessibility, Thomas noted. He recommended using alt tags, ensuring that images are describes and using appropriate headings.
“The vast majority of the accessibility issues that we pick up are within the platform – things that your supplier is providing for you,” he said. “Suppliers should be taking care of these things for you. It’s very easy for suppliers to say that they meet the standard, and in an ideal world when the site is first launched it probably does. But it’s an ongoing process.”
Moving onto analytics, Thomas said: “Once people are getting through the front door, you need to understand who is on your site and how they are using it. Our platform includes something that we call privacy preserving analytics… We call it this because we don’t use cookies. That means that we are not tracking the patient across multiple websites, our analytics are based on what we can see from our side of the system.” As a result, Iatro don’t need to implement a cookies pop-up.
Within the Iatro system it is possible to view live traffic. “You can see how much patient traffic you are getting, day-by-day and hour-by-hour, but that’s only half of the story,” Thomas said, adding that the analytics will tell you “what devices they’re coming from, what they were researching to get to the site, what they were searching once they were on the site, and crucially what they ended up doing as a result.”
Thomas went on to display an example of a report that the analytics can produce, available to view at 09:49.
Navigation and content
“When it comes to understanding what patients are navigating the website for, it can be easy to think that it’s a good idea to put every offer on the homepage and make sure everything is a click away,” Thomas said.
According to Iatro’s research with patient groups, “the more you offer them the less important it become. More choice doesn’t equal more conviction that they’re clicking the right thing. It can introduce some doubt that they are following the right path.”
Generally, he said, “Research shows that if you can get a patient to make a click, to engage, then they are more likely to continue doing so. It’s better to have some top sections that dive down into further options.”
Iatro’s platform collects data on 16 million patient visits a month. Thomas lists the most common reasons for patient visits in their experience: appointments, repeat prescriptions, new patient request, updating contact information and registering online.
It’s good to conduct your own research into this, Thomas suggested, but ultimately these tend to be the main reasons a patient might come to your practice website. “Make these things the main focus, make them really obvious and clear in terms of how to get to them,” he advised, “and just drop everything else down in the information architecture and layout.”
Patient language
Looking towards e-consultations, Thomas said: “There have never been more online systems in primary care. The pace of change is ever increasing. As practice, you might be adopting more things and more quickly, which is often the right thing to do; but it can become quite difficult for patients to understand. You might have your online services for appointment booking, an e-consult tool, a long-term condition tool, specific apps for mental health or diabetes or blood pressure management for example. If they are all using the brand name of the supplier, then that becomes complicated for patients to understand what they are.” It can also make it difficult to onboard preparations in using the additional tools, and in ensuring good uptake.
Language is key, he said. “We always recommend using patient language,” he said. “If it’s an e-consultation offer, talk about what it actually is. Call it ‘get in touch online’… it’s nothing technical, but it’s something that a practice could do today to really change the experience of a lot of patients who might not be tech savvy. Even if you are tech savvy, if you’re feeling unwell when you’re trying to access these tools, they can provide a hurdle cognitively.”
At 17:09, Thomas displayed a graphic demonstrating the traffic that Iatro saw coming from desktop smartphone, tablet, other sources and unknown sources in the past year. The vast majority of patients visits are happening on smart phones.
“It’s often very difficult for practices to understand that,” he said. “You’re using your editing tools within the desktop browser and it’s not always easy to see how that would look on a mobile.”
He suggested that the audience have a look at their practice website on their mobile to test how easy it is to navigate for the majority of patients.
Scheduling content
“One thing that’s really useful when it comes to content is being able to shape the demand by scheduling the content,” said Thomas. “You can schedule not just a page but also individual bits of content within the site to only appear at certain times of day.”
The obvious offer and usage for this is around e-consultations, Thomas noted. If the e-consultations are not available out of hours, it prevents patients from following a journey on the website that will end in them being told that the service is unavailable. “You can either not promote the offer, so the link disappears out of hours, or what’s better; tell them on your website that the offer isn’t available at the moment what they can do instead.”
It is also useful for making sure that specific information is displayed at the right time, he said, such as bank holiday opening hours or extended access offers.
Looking and feeling like the NHS
“I spend a lot of time telling practices that it isn’t about making all websites look identical,” Thomas said. “It’s about having a family resemblance. You want patients to understand that this is an NHS site that is following certain standards and those standards also carry through to their care.”
You can do a lot within the NHS framework, he said, and you can still give the website a distinctive look. “It’s important for practices as independent organisations, for patient attraction, and for making people feel that they want to register there,” he acknowledged. “But equally, you want patients to use your website easily and complete the tasks that you want them to. So it’s really important to make sure that the website can be trusted, that it’s validated. That includes links to third-party services.”
Thomas reflected on a past audit from seven different practices from one PCN around extended access, which saw them each taking the time to create their own content whilst providing different routes for patients to get to the same information. “It’s really important is to look at a system that allows you to broadcast and manage content amongst multiple practices. We’ve got great features for this, other suppliers have similar features too. In this PCN, for example, you could write content once and share it out amongst yourselves. So you’ve got the same content at the same time, it looks the same; and it’s promoting the same thing in a really cohesive way. It saves times for patients, and the practice as well.”
Practice365
Finally, Thomas came to Iatro’s Practice365 platform.
He described it as a “complete publishing platform supporting 60 million patients a month. So a lot of this data that we’re getting is really well backed up by what we are doing.”
The important element for Thomas personally is the customer service. “Even though we are a tech business, the technology is probably the most least important thing about what we do.”
He continued: “Some of these features around accessibility in digital signposting are built into the platform for you; so you can make sure that things work, and work well. You can share content in a way that makes sense. You can signpost effectively to any of those digital services without the practice doing all the work.”
Regarding setting up practice websites and transferring them across to the platform, Thomas explained that it is a simple process. “The team will move everything across for you. They’ll tidy it up at the same point – if you’re missing anything they can let you know, for example if you’ve got an outdated privacy notice somewhere. The team understand all those things that have to be on the website.”
The Iatro team can also make amends to the website, and will liaise with current suppliers and hosts to manage transfer without downtime. There is ongoing support via telephone and email, with central content publishing, reporting, an image library and ongoing development included.
In terms of pricing, the all-inclusive cost is £395 plus VAT. “There are no set up charges in year one and there are no hidden costs for support,” he said.
At this point, Thomas took questions from the audience, starting at 26:08.
Many thanks to Thomas for sharing his thoughts and time with us.
You can watch the recording here.
