The Ancient Farm

The last couple of weeks have been good, and we’ve made decent progress. They have also been short weeks, with a two-day hackathon taking up some of last week and four-day weeks for most of us this week.

We’re also down two designers and onboarding a new temporary user researcher. Despite that I think progress has been good.

Planning how to test our user-centred design hypotheses

During a planning session talking about which experiment to prioritise next, we spoke about two constraints: we don’t have any baseline data for the current experience so can’t do comparative studies to show we’ve made improvements; and proving we’ve made the experience better is almost impossible without access to real patients, their data, and a longer period of time to measure outcomes.

We can, however, run experiments that indicate a direction to move in, and may create the opportunity for those more objective tests to be run.

After a couple more conversations planning our research methodology and the first baselining study, we’re now preparing interview guides, recruiting participants and outlining what prototypes we need to run the study.

Planning how to test our technical hypotheses

An event-storming workshop I ran last week helped us discover, in more detail, the questions we still had around how things work now and how things might work. For example, we weren’t totally certain how a service processed a result from a lab. And we weren’t entirely sure about the conditional logic in the app for displaying test results.

So we set up chats with teams, explored their data models, looked at code, and spoke to adjacent teams during the hackathon. It built up a much clearer picture of everything, meaning our tech lead could propose the first technical spike – and by far the riskiest assumption.

Again, great progress. Admittedly we’re limited in what we can learn as we don’t have access to real patient data, but it may prove out an approach.

I’m also on the horn to OpenSAFELY, hoping they can help us run a statistical analysis of pseudonymised patient records held by GPs across the country. This is what would help inform the reliability of the approach at national scale. This analysis will be on the consistency (or quality) of patient record data across suppliers. Everyone knows it’s hugely variable through experience of working with it, but as far as I know there are no definitive statistics on patient record data at national scale.

A testable belief

My hypothesis is that data quality across suppliers is poor, and not high enough to support the national roll-out of any of our ideas. I’m open to being proven wrong, but realistically there’s a reason that teams are only able to make limited, tactical changes to services providing patients their data. And the concept of a Single Patient Record is being discussed for the same reason, presumably.

This is a personal belief based on my experience and not a view of any contracting parties between me and NHS England, but the virtual duopoly of GP IT systems is a problem, and the existing standards and frameworks don’t apply enough leverage to solve it.

It’s a market-shaping problem. Switching costs are massive for GP surgeries, and barriers-to-entry are high for new market entrants. Despite what the Competition & Markets Authority say, existing mechanisms do not mean the market is competitive.

But I’ll get off the soapbox: it’s not my game to play or the immediate focus.

Other things

  • Went to Butser Ancient Farm to see some prehistoric, Romano-British and Dark Age buildings in action. Experimental archaeology is dope.
  • Enjoyed a long birthday weekend in Lille with friends. It’s only an hour-and-a-half away by train, is a walkable city and has great food and wine options. Hot recommend.
  • Wrote a case study on rapid prototyping with AI and pulled together testimonials about Boring Magic.
  • I enjoyed The Odyssey, especially the Cyclops scene. More films like that please. Also think it’d be fun to adapt the Mabinogion into a film (no idea if it has been done before).
  • Started reading The Living Mountain by Nan Shepherd and it is a treat.
  • Another long weekend near Pisa coming up, plus my first experience driving abroad…on Italian roads. I am bracing myself.

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