The Digital Front Door in the Context of Healthcare

A “digital front door” is an app that provides the first point of contact for a patient. One example is an app from England’s National Health Service (NHS), which assists in making general practitioner appointments, ordering “repeat prescriptions,” monitoring “long-term conditions,” and accessing 111, the UK’s non-emergency medical hotline [1][2]. Countries without a digital front door, like the United States, should realize its potential benefits, including increased patient satisfaction and reduced transmission of infectious diseases.

The Journal for Healthcare Quality published a study of over 35,000 American adults receiving ambulatory care, reporting that the main statistical driver of patient dissatisfaction is time spent waiting [3]. Suppose that, instead of visiting in-person, the patient schedules an appointment and reports their symptoms through a digital front door. The healthcare provider uses analytics and human insight for triage, scheduling the patient at a specific date and time. As a result, the patient saves time in several ways. They are seen quickly, reducing the waiting-room time. The practitioner mainly asks clarifying questions, reducing the exam-room time. If the online report warrants a medical test, the patient can obtain said test before or during their appointment, reducing the delays associated with testing. Even with just the two features of describing symptoms and scheduling, a digital front door can increase patient satisfaction, “associated medical practice outcomes,” and even the provider’s “financial performance” [3].

During public health crises, such as the current COVID-19 pandemic, the digital front door facilitates social distancing without diminishing medical care. For instance, providers can set up virtual appointments with patients who exhibit symptoms of the infectious disease (or who have already tested positive). Likewise, patients in higher-risk populations could reduce their risk by decreasing their time of exposure or scheduling entirely virtual appointments [4]. According to an article from the New England Journal of Medicine, over fifty health systems in the United States––including Jefferson Health, Mount Sinai, and Kaiser Permanente––already have the infrastructure for virtual appointments and other telemedical interactions [5].

Despite interest in telehealth among American practitioners, there are no national systems or apps to facilitate telehealth. Nevertheless, insights from the NHS digital front door app can inform future decisions and developments in the United States. First, any app needs a developer and a maintainer. The NHS app is developed and maintained by NHS Digital, a public office with broad responsibilities regarding digital services and healthcare [1]. In the United States, the responsibility might fall to a federal or state government, or a corporate entity. Second, the app might accommodate third-party developers for specific add-on features. For instance, the NHS app has integrations with “external health tech companies,” such as automatic appointments if a patient’s glucose levels become abnormal [1]. Other issues to consider when implementing a similar system include compatibility between providers, the overall organization of the app, and willingness among providers to participate [4].

To conclude, the digital front door digitizes the first stage of patient-practitioner interactions, saving time and resources. However, despite best efforts from stakeholders, this app will encounter limitations throughout its deployment. For users, many features of the app might raise privacy concerns, requiring policy and technical solutions. The app requires Internet access or a data plan, making rural and poor urban areas less likely to use it [6]. Likewise, older adults and adults with certain disabilities may use the app less often, if at all [7]. Nevertheless, a digital front door will be an important part of the broad telehealth initiatives that are gaining traction across the country.

References 

[1] Best J. The NHS App: Opening the NHS’s New Digital “Front Door” to the Private Sector. BMJ 2019; 367: l6210. DOI:10.1136/bmj.l6210.   

[2] New NHS App Will Make It Quicker and Easier to Access Health Services. July 2, 2018. Retrieved August 20, 2020 from https://www.gov.uk/government/news/new-nhs-app-will-make-it-quicker-and-easier-to-access-health-services.  

[3] Michael M, Schaffer S, Egan P, et al. Improving Wait Times and Patient Satisfaction in Primary Care. Journal for Healthcare Quality 2013; 35: 2. DOI:10.1111/jhq.12004.  

[4] Portnoy J, Waller M, and Elliott T. Telemedicine in the Era of COVID-19. The Journal of Allergy and Clinical Immunology: In Practice 2020; 8: 5. DOI:10.1016/j.jalp.2020.03.008.  

[5] Hollander J and Carr B. Virtually Perfect? Telemedicine for COVID-19. The New England Journal of Medicine 2020; 382: 1. DOI:10.1056/NEJMp2003539.   

[6] Howard P, Busch L, and Sheets P. Comparing Digital Divides: Internet Access and Social Inequality in Canada and the United States. Canadian Journal of Communications 2010; 35: 1.  

[7] Hargittai E, Piper A, and Morris M. From Internet Access to Internet Skills: Digital Inequality among Older Adults. Universal Access in the Information Society 2019; 18: 1. DOI:10.1007.s10209-018-0617-5.