Exploring how to improve test result designs in the NHS Wales App

Nia Campbell, Senior Content Designer at Digital Health and Care Wales 

Test results are available to many patients using the NHS Wales App. The ambition is to ensure all patients have access to this feature, and increase the range of results that can be accessed.

Our in-app survey told us that patients value that access and the convenience of not having to contact their GP practice for their results.

But access is only part of the story.

What happens when someone sees a result they do not understand? Do they know what it means for their health? And, importantly, whether they need to do anything next?

These are some of the questions we have been exploring as we look at how we could improve test results in the app.

We're working in small increments, learning and improving as we go. Our current focus is the test results landing screen and how individual results are presented.

And although our user-centred design team brings different skills to that work, we have needed many more perspectives to understand the problem.

User research: access is not the same as understanding

Our user researcher started by reviewing existing evidence about how patients access and understand their test results.

We also spoke to the NHS England test results team about what they had learnt from their own work.

Three needs stood out.

Patients want help understanding what a result means for their health. They want to know what happens next and who is responsible for following up. And their understanding of a result is often connected to knowing why the test was ordered in the first place.

That gave us a useful baseline: showing someone their health information does not necessarily mean they can understand it.

We used that evidence to develop early ideas and tested them with seven patients across Wales.

Their feedback has helped us understand where we are making things clearer, and where we still have work to do.

Service design: a result is only one part of the journey

A test result does not begin when it appears in the app.

Our service designer mapped what happens from someone visiting their GP and having a test through to receiving their result.

We worked closely with GPs to check that what we had mapped reflected what actually happens in practice. That gave us a shared view of the people, processes and technology involved – and helped us identify risks, gaps and opportunities along the way.

Some of those details matter a lot.

For example, results from tests taken at the same time do not necessarily come back from the lab together. A patient might be concerned that their results are taking so long, but on the other side, the GP might be waiting for other results before they can understand the full picture.

We have also been working with our developers to understand exactly what coded information can pass from GP systems into the app.

That work has uncovered some anomalies that we are investigating with EMIS and our patient safety colleagues because of their potential impact on patient safety.

Looking beyond the screen has helped us see things we might otherwise have missed.

Content design: what do people need to know when?

As we understood more about the service, we also uncovered different information needs.

Patients need help understanding things like reference ranges and somewhere trustworthy to find out more about their test.

GPs want people to know that results can arrive at different times and that reference ranges do not always tell the whole story for every patient.

Our service desk needs to be able to help people with questions about the app, while making it clear that questions about the meaning of a result need to go to their GP practice.

Trying to explain all of that on every screen would create another problem.

Our content designer has been working through what someone needs to know when they see their result, what they can choose to read more about, and what is better handled through supporting guidance.

When is extra information useful, and when could it be overwhelming? Sometimes improving understanding means adding information. Sometimes it means knowing what to leave out.

It's about the right information, at the right time, presented in a way that makes sense.

Annotated test results designs showing the existing designs and work in progress.

Interaction design: turning what we learnt into something people can use

Our interaction designer has been considering the visual components that can support patients in making sense of their results.

The current test results design presents results in one long list. For someone with hundreds – or even thousands – of historic results, finding what they are looking for can be difficult.

So we've explored a landing page that helps people navigate their results by year, see how many results they have, and identify results they have not yet opened.

We're also looking at how we present the results themselves.

Does showing the healthcare professional's comment earlier help someone understand what their result means? How can we make a set of numerical results easier to scan?

Our developers have helped us understand what is technically possible. And by testing early prototypes with patients, we've then had opportunities to work with our GP colleagues to iterate the designs.

And each time we learn something, the design moves on.

The value is in working together

One of our biggest reflections from this work is how quickly a seemingly simple feature takes you across the whole service.

Research about patient understanding led us into clinical processes. Understanding those processes led us into the underlying data. Looking at the data raised questions about safety. Testing designs with patients gave us questions to take back to GPs and developers.

And working through the designs has helped us identify what we need from colleagues in laboratories, patient safety, service support, business change, and communications.

No single discipline or profession could answer all of those questions.

And the work has not moved neatly from research, to design, to development. We have been moving between them: testing assumptions, finding new questions and bringing in the people who can help us answer them.

That, for us, is the value of working as a multidisciplinary team.

It's not just about having different professions involved. It is about bringing the right people together at the right time, and giving them the space to learn from each other as the work develops.

Because making test results available is one thing.

Helping people make sense of them is something we have to design together.