What is a patient portal?

Just like AI in the wider IT industry, Patient Portals have become a recent trend among NHS secondary care providers in an attempt to improve overall patient experience and consolidate patient facing services into a unified interface. Until recently, patient facing services such as appointment management, documents & questionnaires and Patient Initiated Follow-up (PIFU) were typically exposed as separately accessible entities, with the former requiring a dedicated telephone call to the service providing the appointment to cancel or rebook. This resulted in a fragmented experience to the patient and felt outdated in an increasingly digitally-led landscape.

Today, many NHS Trusts across the country now expose a patient portal – a website which allows patients to interact digitally with their healthcare provider. As well as a highly improved patient experience, patient portals offer significant cost saving opportunities by reducing administrative burden[1] and, by giving patients more control over their healthcare, this could potentially lead to a reduction in the number of appointments marked Did Not Attend (DNA) – a key performance marker for NHS Trusts.

As is typical in the NHS, there are often organisations who do not have the expertise internally to develop a patient portal of their own, or would prefer for the responsibility of maintaining the system to be driven by a commercial supplier. Unfortunately, what this means is, is that across the country we have a mixed picture of commercial and Trust-led patient portals with varying levels of functionality and user experience.

NHS Wayfinder programme

Supporting the NHS '10 Year Health Plan for England' and developed by NHS England (formally NHS Digital) is the rollout of the Wayfinder programme. Also known as the Patient Care Aggregator, the Wayfinder programme is an initiative for secondary care providers to integrate appointment information and available documents & questionnaires into the NHS app.

NHS Trusts onboarding to the Wayfinder programme are required to expose an NHS-styled patient portal which a patient can ‘deep-link’ to from the list of appointments shown within the NHS app. The patient portal you expose should allow a patient to view more information about their appointment and manage it by providing a cancel/reschedule facility if the treatment function allows. The NHS-styled patient portal ensures a consistent look and feel for the patient whilst using the NHS app.

As an NHS Trust who is looking to onboard to the Wayfinder programme, you might be interested to learn what’s involved before getting started. In this article, we will look at the relevant documentation submissions required, as well as the requirements from your software development team/commercial system supplier. It is worth pointing out that this article is specifically focusing on onboarding for Appointments - Documents & Questionnaires is out of scope, but the onboarding process is very similar.

Underpinning the onboarding process to Wayfinder is the submission of a Supplier Conformance Assessment List (SCAL) which includes evidence sections for both NHS login and Wayfinder itself. If you have never submitted a SCAL before, this is a technical document provided by NHS England which details the consumer supplier approach to information governance, clinical safety, functional testing and evidences of successful onboarding to Wayfinder and NHS login. The SCAL will be provided to you by the Wayfinder team and is typically in the format of a spreadsheet.

Once you have received your SCAL, there are a number of evidences required to complement the submission and these are detailed below.

  • Clinical Safety Case with hazard log DCB0129
  • Completed ‘Standards Met’ DSPT
  • Commissioning Arrangements – correspondence from commissioning body stating the intent to commission the work.
  • Cyber security penetration test for your system offering
  • Architecture Diagram
  • Data Flow Diagram
  • User journey wire frames (NHS app SCAL)
  • Video evidence of different user journeys to NHS login and NHS app branded portal (new user, returning user, consent given/rejected)
  • Evidence of sufficient support arrangements to underpin your service
  • Technical Conformance Certificate – Issued by NHS England once integration has been demonstrated to required standards

In order to receive your Technical Conformance Certificate, you are required to provide a demonstration of your Wayfinder offering to NHS England in their ‘Sandpit’ environment, this provides a welcome opportunity for both parties to review what has been developed in detail and ensure you’ve met the criteria. In total, three environments are exposed by NHS England services: Sandpit, AOS and Production, with the first two being used as test environments.

The onboarding process to Wayfinder is unsurprisingly intensive, and requires significant resource investment from multiple teams at your Trust. Following submission of your SCAL, it will go through a peer review with Subject Matter Experts (SMEs) at NHS England to review your clinical safety case, DSPT, architecture diagram and cyber security assurances.

The next sections of this article will provide high level detail on the integration to NHS login and the Wayfinder patient portal.

NHS login

NHS login is an Identity Provider (IdP) and Authorization Server (AS) conforming to the OIDC standard. It is the de-facto Single Sign-On (SSO) provider for NHS services and has gained large adoption alongside the NHS app since the COVID-19 pandemic. When onboarding to the Wayfinder programme you will need to register your developed system with NHS login, enabling you to receive a Client Identifier (Client ID) and Client Secret so you can authenticate users accessing your system. Even if you are already using NHS login with another system at your Trust, you still need to register – this is because the Client ID you receive is unique to each system using NHS login. Throughout the onboarding journey as you progress from Sandpit to AOS and finally Production, each will need a separate registration to the equivalent NHS login Sandpit/AOS/Production environment.

Once registered with NHS login, you will receive a number of test accounts that you can use to ensure that your Wayfinder offering is working as expected.

NHS login allows external services to enforce a minimum Vector of Trust which will restrict users from accessing the service unless they have verified their identity to the required level. For Wayfinder, the minimum Vector of Trust that the external system must enforce is ‘P9 - Verification & authentication level High: Strong’. The Vector of Trust is configured within the code of your system. The reason the Wayfinder service requires the highest level of trust is due to the sensitive nature of the information being accessed by patients.

There is significant support available by the NHS login team and during the onboarding process you will be invited to join their support community to ask questions if required. Important technical documentation for NHS login can be found here.

Wayfinder patient portal

As a Trust who is onboarding to the Wayfinder programme for Appointments, you are required to design and implement the following:

  1. A FHIR R4-compliant API which returns a FHIR Bundle of Appointments, conforming to the following specification. This part of the system is responsible for displaying appointments for the patient in the NHS app.
  2. An NHS branded patient portal which meets the design specification provided by NHS England. This part of the system allows patients to ‘deep-link’ from the NHS app so they can view more information about their appointment, and ideally manage it too if the treatment function allows. You will be provided with a link to the most recent user interface design when onboarding begins.

The Wayfinder onboarding team will provide you with technical documentation which outlines the Functional and Non-functional requirements that your offering must meet in order to receive your Technical Conformance Certificate. Your system will be heavily scrutinised by the onboarding team and it is very important that you read and fully understand the information you have received.

If you are working with a commercial supplier, the technical side of the onboarding process will be managed by them, but the completion of the SCAL and inclusion of all evidences required will be the Trust’s responsibility.

What to do next?

As an NHS Trust, making a patient portal available for your patients provides them with a modern and improved way of interacting with the digital services you offer. The Wayfinder programme goes one step further still, by enabling patients to view and manage their appointments directly within the NHS app without having to go to a different website.

Throughout this article, you have been given an overview of what is required to successfully onboard to the Wayfinder programme; a comprehensive list of evidences require submission, and the design & development of a functioning system to complement the offering may feel prohibitive for NHS Trusts who do not have the resources to onboard within the required timescale.

Fortunately, the team at IThirtyFour have experience in designing & developing patient portal systems which conform to the high standards required for Wayfinder, as well as a strong understanding of the SCAL submission process which can help streamline your onboarding journey. If you require any assistance with onboarding to the Wayfinder programme, or would like to discuss any of the points raised in this article in more detail, please don’t hesitate to contact us.

References

  1. Bolton NHS Foundation Trust. Digital Letters & Patient Portal. https://www.boltonft.nhs.uk/your-care/digital-letters/