We’re delighted to inform you today of the open access publication from Abi Eccles et al:

“BJGP: Patient use of an online triage platform”

It’s the first independent study of askmyGP and it’s well worth reading in full.  I will quote the conclusion briefly:

“Patterns-of-use and patient types were in line with typical contacts to GP practices. Though the age of users was broad, highest levels of use were from younger patients. The perceived advantages to using online triage, such as convenience and ease of use, are often context dependent.”

What comes through for me is the very ordinariness of the online demand.  It’s the same as normal demand, same patients, same conditions, same frequency by day of week and time of day.

There’s more on patient feedback too, with themes extracted which are very familiar to us.   We’ve quantified the age question in our study on “Age specific adoption of online consultations.”

What this study adds is online usage orders of magnitude greater than any previous paper, with 5447 patient episodes from 9 practices in 10 weeks.  Data collection was May to July 2017, which was our previous version 2 platform.  Since then the same principles have been carried forward to v3 with a new design and many more features.  Growth in usage means that we are now collecting the same volume of data roughly every two days.

The scope for further research is increasing daily with an anonymised database of some 300,000 episodes, unique in general practice.  If you’re an academic in the field, we welcome the opportunity to collaborate, particularly on studies of the GP practice as a whole, not just online components.

Benefits for patients and GPs are the product of system change.

Regards,

Harry Longman

PS See how patients interact with askmyGP on our Bramley Demo Practice.

To experience the GP side, start with our free online demo.

Context

The latest data from our chief analyst Dr Steve Black (@sib313) shows remarkable adoption of online consultations across all ages and 10 diverse practices.  n = 37,674 requests, date range is 1/1/2019 to 8/2/2019.

The context is all askmyGP practices operating in “total flow” mode where all patient demand goes through the system in two modes.  Online, patients submit a request for help from their NHS GP practice either for themselves (dark blue) or as a proxy (light blue), mostly children but also vulnerable adults, most over 75.  They may also telephone the practice, and a receptionist creates the request on their behalf (orange).

The key point is that all demand is covered in the chart, not from a self-selected subset of patients, and these are regular GP practices where there is no change in registration.

What the data shows

For infants and children, over 60% of parents chose to send their request online.

For young adults aged 20 – 40, over 70% submitted online.

With increasing age, the proportion online falls slowly, but even at 65 – 70 it is 40%.

Over 70 the proportion falls more steeply and significant numbers are by proxy.

Policy implications

It is clear that when designed for ease of use and universality in respect of patients and their medical problems, coupled with rapid response by providers, the online offer is highly attractive to patients.

The vision for “digital-first” providers who are at the same time traditional, local GP practices is achievable and already being achieved.

Harry Longman

Founder, Chief Executive, askmyGP

The “Flaw of Averages” was I understand first observed when a trainee statistician drowned while fording a river which he calculated had an average depth of 2 feet.

You can tell he was American.  A British trainee would have made the average depth 0.945m.

We are seeing 7,000 online consultations per week through askmyGP, from about 250,000 patients covered.  At 2.8% of total list, that would be about a third of total demand on average, right?

You know I’m going to say “wrong” and the flaw explains very simply why.

It turns out the practices divide into three cohorts, which I’ll call the swimmers, runners and rollers.

The swimmers see under 5% of demand online.  There may be a lot of splashing, but speed over the ground is quite low, benefits are hard to measure and an adverse current may even sweep them away.  An askmyGP icon decorates their website, leaflets and posters are all over reception but for any patient using it, service is slow and frankly, the telephone seems a safer bet.

Runners are in the range 20 – 40% online, it’s a main mode of access with good service and generally high patient satisfaction.  Benefits for the practice are significant and they can handle all patient demand on the day.  But they are still running two systems, with mixed messages to patients.  While they know online is more efficient, they may still limit access, so patients revert to telephone.

Rollers are putting 100% of demand through askmyGP, between 50 and 80% online from patients, the rest by telephone into reception.  In this total flow mode, GP digital triage means they manage all their workflow with an efficiency simply impossible by any other means.

What does this mean for us?

We want to increase usage because, while we incur some volume related costs, it’s much more valuable to us when customers and patients get the most benefit from askmyGP, and that is after all our vision.

But while it might be tempting to persuade, cajole or incentivise practices to push up their average % usage by a few points, it would be a waste of everyone’s time.

Quite simply, we need to get them all rolling along in total flow mode.  They’ll experience the benefits all for themselves with no pushing and shoving from us.

Here’s the thing:  all our customers have exactly the same software, and the same advice.  They are just making different choices, and seeing radically different outcomes as a result.

The great news is that all our new launches are rolling from day one.  It works best that way.

Any triathletes will have spotted the analogy but there’s an added twist:  transition between the modes seems to be remarkably difficult.  People settle into a mode of operation and to shift seems just, well, a bit of an effort.

It’s not impossible, with Witley & Milford shifting three weeks ago and immediately doubling their speed of flow.  After one week, someone briefly went back to the old system and was very quickly corrected!

So while new practices are all getting the max, how do we move the others?

Scratches head.

Harry Longman

PS What about the spectators?  Very simply and with no commitment, you can be the GP managing the incoming total demand.  It’s real, randomised and anonymised patient data, and when you have your login it will take about 15 minutes to rattle through 50.

Register for our free Digital Triage Experience.