https://publichealthmatters.blog.gov.uk/2016/07/22/%ef%bb%bfthe-a-z-of-digital-public-health/

The A-Z of Digital Public Health

digital

Public health has gone digital. Digital public health is emerging as a blend of old public health wisdom combined with new digital concepts and tools – a joint venture.

Five years from now there will be no separate digital programmes, we will just have mainstreamed it into our ways of working.

Digital is not just about new technology and tools, above all it is about putting users and people in the middle of what we do; it is about using data properly; it is about a new open, faster culture.

Does that sound like public health? I think it does.

The majority of these terms are relevant to digital public health anywhere with a few that are specific to Public Health England - please do propose more in the comments section below.

If you want to explore further, try

Agile. In public health bodies and in government we predominantly use ‘waterfall’ project design, a sequential process, where you set a goal at the outset and then hand work on from one person or group to another, with often a panic towards the end to meet a predetermined set of outcomes and a deadline. This does not work well in digital: an ‘agile’ approach is needed. There are 12 principles in the Agile Manifesto, written by a group of independent thinkers about software development in 2001.

AGILE MANIFESTO

Agile is iterative – build, test, improve. It requires people to sit and work closely and frequently together, with full engagement to problem solve, ‘sprints’ of work lasting 2 weeks or so and daily ‘scrums’ with the development team checking in on their work. You must use the agile approach to project management to build and run UK Government Digital Services. Agile is best learnt by joining in an existing agile project, online learning via a MOOC (massive online open course), the Agile section on the GDS website, or going on a course. You can download a free and rather useful copy of Agile for Dummies here.

Alpha.  This is the first stage in actually building a digital product or service and follows on from Discovery. As set out in the UK government digital design manual: in alpha you build a prototype, test it with users and learn from it.

USER needs

API. Application Programming Interface. This is a set of routine definitions, protocols, and tools for building software and applications. It is all about loosely coupled architecture as digital development moves so fast you do want to build a jigsaw of connected pieces of software – this will allow you to change your system over time, replacing out of date sections and adding on new sections.

API’s are essential to connect up the jigsaw of digital architecture. They are the ‘glue’ that hold the various bits together and allow data streams to connect.

App. This is short for Application Programme – a piece of software that can run on the internet, on your computer, on your mobile phone or on another device. Apps are increasingly used in public health – try Public Health England’s Sugar Smart, which uses your mobile to scan barcode information and tells you how many sugar cubes are in food items. Sugar Smart is a native app – designed to use the features of a device, in this case, the camera on your phone. There are also web-based apps, and hybrids (a combination of both). This study by the IMS Institute for Healthcare Informatics in September 2015 found 165,000 health-related apps, with a mere 36 comprising nearly half of downloads. Connectivity to sensors and wearables drives use.

Sticky Apps. Stickiness is anything about a mobile app that encourages the user to remain engaged and stay longer – good user experience means users will come back again. Here is a useful list of ten things that make an app ‘stick’.

Android. A mobile operating system (OS) currently developed by Google, based on the Linux kernel and designed primarily for touch screen mobile devices.

Approvals Process. All digital products and services funded within UK central government must go through an approvals process. The GDS steps for this are here. There are additional steps within PHE and the DH which together form the approval process for PHE’s Digital spending – public health staff elsewhere should check within their organization for any approvals or guidelines you should follow. For public health practitioners, following GDS standards and guidance will give you a better product, and will also lead you to question how you build things. Expect these standards to evolve as we learn more.

B2B. Stands for Business to Business but better understood in public health terms as professional-to-professional or organisation-to-organisation. Sending public health advice from PHE on stopping smoking through a smart phone app is B2C (Business to Customer). Creating a digital solution so our local public health teams can interact effectively with local authority teams would be B2B.

Barriers to change. There are usually two main barriers that will slow down or prevent digital transformation of an organisation – culture, particularly leadership culture, and a lack of investment (time, effort and money). Culture eats strategy for breakfast every time!

Benchmarking. Before an organization starts on a digital transformation journey, it is very useful to benchmark where you are by a capability audit, skills assessment or a strategy review. It can be a wakeup call for senior management. NHS England has created a self-assessment digital maturity tool, which is worth a look for public health folks too. And here is a digital maturity assessment matrix for the 3rd sector.

Beta. This is scaling up a digital project and going public. You’ve tested your solutions to user needs and built up a clear picture of what it will take to build and operate your service. In Beta, you build an end-to-end service, test it in public and prepare to go to the next stage, which is Live.

Consent. If the public will trust health and care services with their data, there can be huge benefits for all of us. However, the public need to be told about what is happening with their data and to be given a choice. Fiona Caldicott, the National Data Guardian has lots to say about this.

Channels. The ways in which you can distribute a product digitally. For example a piece of public health advice could be distributed via social media, shared on a websites, streamed over the Internet, placed on YouTube etc. It is all about what works best for a particular user – the opposite of ‘one size fits all’ broadcasting of information.

The Cloud. In the simplest terms, cloud computing means storing and accessing data and programs over the Internet instead of your computer's hard drive. The cloud is just a metaphor for the Internet. It goes back to the days of flowcharts and presentations that would represent the gigantic server-farm infrastructure of the Internet as nothing but a puffy, white cumulus cloud, accepting connections and doling out information as it floats. Heard recently? The cloud will become our extended soul.

Content Strategy. Writing for the web and mobile is an important public health skill. Content that meet these standards will be searchable, easy to read and understand. We have just created one for PHE.

Customer Relationship Management System (CRM). CRM is the glue – not just the tech. It is the ever-evolving data, the process, the thinking about how to engage with your customers, colleagues and other users. Formally it refers to practices, strategies and technologies that an organization can use to manage and analyze customer interactions and data throughout the customer lifecycle, with the goal of improving relationships with customers. In practice it is all about how we talk to each other – our colleagues, our stakeholders and partners and the public. A CRM allows these conversations to be more personalized.

A CRM can be more complex in government than in the private sector, and here are some reasons why. For PHE the CRM we have started to design will help us engage more openly and in a two way process internally, with our partners, and with those we serve, including citizens.

Customer focus. Digital transformation should be customer led. This means defining your customers or ‘users’ and understanding what they want, by asking them.

Design thinking. Based on the theory that ideas scale quicker than people. Clear principles, based on evidence, set ways of working all help shape decisions about product and service design. All services delivered by GDS are based on their design principles. As well as learning the phases of agile projects and of digital development, some of you may like to go deeper into the background of design processes. This article is interesting as it looks at the creative process itself, how something can be developed from scratch and puts this right at a human level. Read this, and then you might appreciate why waterfall (see under W) processes might be familiar, but they are seriously limited.

Data. Digital approaches experiment constantly, using data to drive design. This should put public health data right at the core of what we do, and we are talking LOTS of data, live data, user data, and messy data… BIG DATA. Data sources will be increasingly connected and data will increasingly meet open data standards. Digital is all about connecting data sources and empowering people to dive in for insight. Totally public health!

Digital. In PHE Digital services include (but are not restricted to) hosting, domain registration, mobile applications, collaboration tools, the intranets, social media tools, maintaining and/or redeveloping existing websites and development of new websites. I am reminded of the old joke ‘ drink coffee and do stupid things faster’. Doing the same old stuff digitally misses the point – digital tools and ways of working offer a chance to transform what we do and how we do it.

Digital inclusion. Some populations are isolated and excluded from the digital realm. Digital inclusion has three parts: access, adoption, and application. When developing digital services, you need to be mindful of these factors. This is really important for public health services.

Digital by Default Service Standard. This is required for all UK government digital projects.  There are 18 points that must be met. If a digital service does not pass these 18 points it will not appear on GOV.UK.

Digital Maturity. An important step for any organisation – a benchmarking exercise which can allow you to track progress. Here is a link to the Local Government Association’s assessment tool.

And here is NHS England’s framework.

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This recently published overview of digital maturity across 239 NHS Trusts in England shows results, as you might expect, are mixed.

Discovery. This comes before building anything. Digital design always starts with a problem that you want to solve; otherwise it is just electronic art. In discovery you find out what your users need, what to measure and what your constraints are. It is followed by Alpha phase (see above).

Education and awareness. For public health to really use these new approaches, we will need leaders that understand digital, managers who can lead product development and work in an agile way, policy makers who can truly engage with user needs assessment, and writers who can develop digital content. Lots of new standards to understand and tools to work with. Are you digitally aware? How will you raise your skill level?

Failure. A culture where you can fail fast, learn and iterate is essential. This is different to traditional public sector approaches, which require you to try and get it right first time. If I am wrong, tell me!

Freemium is a pricing strategy by which a product or service - typically a digital offering or application such as software, media, games or web services - is provided free of charge but a premium is charged for proprietary features, functionality, or virtual goods

Gender and Diversity. Go to tech events and if you are a woman you will probably be in the minority, often a minority of one. There is a gender diversity problem in the digital industry. Diversity leads to more robust decisions and better-led organizations.  As of May 2016 no one from the Government Digital Service will take part in a panel discussion of two or more people unless there is at least one woman on the panel, not including the chair. Should it PHE do this?

Google analytics. A freemium (see freemium above) web analytics service offered by Google that tracks and reports website traffic. Google also provides an analytics service for mobile and apps via Firebase Analytics.

Governance. A good digital governance framework is an enabler, which allows for creativity and faster decision-making. Digital governance is a framework for establishing accountability, roles and decision-making within an organisation.

Government Digital Service (GDS). Part of the UK Cabinet Office. "Our job is digital transformation of Government… and transforming the relationship between the citizen and the state”. Find out more here.

Hackathon. An event, sometimes lasting a few days, where developers, programmers, designers other experts get together to collaborate on software/digital products. For instance PHE recently held the HealthX hackathon to work on apps and tools that can get young people eating better and moving more.

HTML/ Hypertext Markup Language. A language used by developers to create websites. Key point – content written in HTML can be searched, downloaded into a PDF file, translated by Google, machine read by devices for readers with poor sight, read out loud by devices for the deaf etc. Much more accessible and usable than content loaded onto the web as PDF files.

Inclusive design. It is no longer enough to just meet the technical requirements of building an accessible service. Every design decision has the potential to exclude someone and all PHE digital products should be accessible to, and usable by, as many people as reasonably possible without the need for special adaptation or specialised design.

Innovation Lab. A good ways to try new things out – labs may be set up with an organization, or externally (for example the Farr institute in Manchester led by Prof Iain Buchan).

The Internet of Things (IoT) is the network of physical objects or "things" embedded with electronics, software, sensors, and network connectivity, which enables these objects to collect and exchange data.[1]

Interoperability. The extent to which digital systems can interact with each other. Interoperability is typically used within a healthcare context. It is can achieved through open standards and APIs or systems could be connected together post facto in an environment where a small number of suppliers dominate the market or if standards were not available when they were created. Much of the interoperability work in the health system is post facto. This short interview with Beverly Bryant, Director of Digital Technology in NHS England puts this in a health context.

Job Descriptions. Old ones will need to change and new ones developed. This is going to affect everyone from leaders who may well have to run digital transformation, managers who may well end up managing the development of digital projects and working in an agile way, analysts who will need to grapple with new kinds of data from digital projects. Five years from now digital will be the business of everyone in public health and will be mainstream.

Live. This follows Beta Phase in service development. The work doesn’t stop once your service is live. You’ll be iteratively improving your service, reacting to new needs and demands, and meeting targets set during its development.

Meta Data. This is data about data. So in public health when we see a mortality figure the Meta data will be source of numerator and denominator, method of calculation, indicator specification and validation, date of the figure etc.

An everyday example would be: Alice and Bob send text messages to each other throughout the day as they move between home and work. The data is what is said in the text conversations and any pictures that were sent. The digital Meta data is text size, location, mobile mast used, device id and and information about the plain text or pictures (but not what was said or seen).

A public health example: the PHE Sugar Smart app allows the user to scan products found in supermarkets and shows the user how much sugar a product contains with the visual aid of sugar cubes. The digital DATA the app collects is which products are being scanned. The digital METADATA is - what was the location when the user scanned the product, what time, what device type etc. The public health DATA would be rates, numbers and types of people who search, compiled rates of sugar load searched and hopefully as it gets more sophisticated, data around behavioural change. The public health METADATA might include source and data attached to this data, description of an indicator and the rate, and any source of validation.

Mobile. Refers to all handheld devices such as smart phones or tablets. The technology moves like lightening and the ability to generate data, interact with directly with users, and create new tailored relationships is transforming public health.

National Information Board (NIB). The NIB brings together national health and care organisations from the NHS, public health, clinical science, social care and local government, along with appointed independent representatives to develop the strategic priorities for data and technology. It is currently chaired by John Newton, PHE’s Chief Knowledge Officer and will be chaired by the new Chief Clinical Information Officer and Chief Information Officer from NHS England once they are in post.

Open Data. Data that anyone can access, use or share. Simple as that. The Shakespeare Review identified £6.8bn of total value in UK public sector data, a report in 2011 estimated that the EU market for public sector data would grow to €40bn per year, while McKinsey estimated a global market powered by open data from across seven sectors would create between $3tn and $5tn a year. Learn more with the Open Data Institute.

Open standards. An open standard is a standard that is publically available, has various rights associated with it, contains a specification for how something should be built, and may also itself have been designed in an ‘open’ way. Open standards are essential for interoperability and a platform approach. The Internet is one of many systems built on open standards (W3C).

Pay-Per-Click (PPC). Also called cost per click (CPC), is an internet advertising model used to direct traffic to websites, in which an advertiser pays a publisher (typically a website owner or a network of websites) when the ad is clicked. Can be used in public health marketing campaigns.

Personally Identifiable Information (PII). Information that can be used on its own or with other information to identify a person for another and could be used to contact or locate a single person or for de-anonymizing anonymous data.

Platforms. This is one term that means different things to different people. It usually refers to a shared digital infrastructure – interconnected components of a larger system. NHS Choices is a platform. ‘Government as a Platform’ is a new vision for digital government; a common core infrastructure of shared digital systems, technology and processes on which it’s easy to build brilliant, user-centric government services. Government as a Platform is a phrase coined by Tim O’Reilly in a 2010 paper. This 2014 video explains the concept. Thinking has moved on a bit since then, but it’s a simple illustration of the kind of thing we mean. In Public Health England we want to take a ‘platform’ approach to all digital products – for example a common hosting solution, shared and reusable software, a code library, data and data sharing standards, an agreed approach to user needs assessment and oversight. It would allow us to maintain quality, compliance and also improve efficiency and save money.

Policy: Digital policy exists to protect the organization. They are guidance statements put in place to manage risk and ensure the core principles of an organization are served.

Product. In digital culture, anything you produce. A product is something that meets a particular user need and can be specified and then produced.

Product owner. The person who is responsible overall for a digital product during design, delivery and future improvement. Successful digital delivery happens when you have a single owner of a product which may be an app, a website, or a campaign who is supported by a team of appropriate experts. A product owner needs to champion the product. This will be you – when you design your public health intervention, which is why digital literacy is important for public health professionals.

Prototype: A low fidelity version of a proposed digital solution for the purposes of user test and user research. A prototype could include sketches or a clickable demo site.

Roadmap. Commonly used term for a time bound, clear plan for a digital transformation. For example in the NHS in England all local health and social care systems will have a local digital roadmap in place by June 2016.

Retirement. Even the best services may eventually reach retirement. Changes in policy may mean that the service is no longer offered or new understanding may mean that those user needs are better provided through a different service. I do not think we do enough of this in public health. Planning in review dates and carefully monitoring usage and user needs will help.

Retrospective. An Agile retrospective, or sprint retrospective , is a way for teams to reflect on their way of working, and to continuously improve. It is the twelfth principle of Agile: ‘At regular intervals, the team reflects on how to become more effective, then tunes and adjusts its behavior accordingly.’

Scrum. Scrum is part of the Agile framework for completing complex projects. Scrum originally was formalized for software development projects, but it works well for any complex, innovative scope of work. There is a useful video here.

Security. Public trust is undermined when security fails. Fiona Caldicott, the national Data Guardian reviews privacy standards are increasingly ‘Information about me’ can be combined to create ‘knowledge about us’. As the calls for data sharing and open data increase, data governance has to shift to keep pace.

SEO – Search Engine Optimisation. The process of affecting the visibility of a website or a web page in a web search engine’s unpaid results — often referred to as ‘natural,’ ‘organic,’ or ‘earned’ results as opposed to what happens when you pay for ads to be placed via search engines. PHE’s new digital content strategy will mandate HTML content rather than PDFs as web pages are more search engine friendly and provide a better experience on mobile devices.

Service Manual (of the GDS). A hugely useful and practical resource for anyone developing government digital services. An absolute must-read.

Slack. A proprietary real time messaging App for teams. Widest used by developers and data scientists, including teams within PHE and GDS. You create ‘channels’ around topics, themes or projects and communities then gather round them.

Stand-up. The daily meeting format for Agile. Originates from just that – the team ‘stands up’ together on a daily basis and checks in. Meetings are held at the same time each day, last only a short time (5 – 15 minutes) can be in person or online and are not postponed if not all the team can be there.

Strategy. Doing what we have always done is no longer an option. We need to understand these six things in public health:

  1. Strategy - where should we be going with digital, where can we add public health value, what should we not do?
  2. People - what teams, talent and skills do we need to get there?
  3. Processes - how should we change the way we work?
  4. Technologies - what platforms, software and data strategy will serve us best?
  5. Resources – what investment is needed?
  6. Timeline – What do we expect to get done and by when?

Silos. Digital approaches don’t work well with maintaining silos, whether organizational, data or thinking. Digital approaches tend to break walls down.

Style Guide. Really important you get this right for all digital content. The UK Government Digital Service style guide covers style, spelling and grammar conventions for all content published on GOV.UK, arranged alphabetically.

Task Management software. There are many examples of these (search online) – they help teams work together, sharing and recording tasks and solving problems. Essential.

User needs and user research. Public health user needs include epidemiology, research, an expert view and various approaches to local engagement and patient or user voice. Digital user needs focus on the customer experience while using a digital product or site, and not on the more abstract ‘needs’ defined by public health. This is a huge source of misunderstanding between digital and public health folks. It is time for a new definition of public health user needs, one that combines both tried and tested public health methods and wisdom and new digital user needs approaches – a hybrid.

User Generated Content (UGC). Blogs, wikis, discussion forums, posts, chats, tweets, podcasts, digital images, video, audio files, advertisements and other forms of media that was created by users of an online system or service, often made available via social media websites. Thanks Wikipedia!

User testing. Testing a prototype with users to find out any usability issues and to allow iteration. Can be combined with user research to gain a better understanding of the person and what they are trying to achieve.

UX - User Experience Design. The process of enhancing user satisfaction by improving the usability, accessibility, and pleasure provided in the interaction between the user and the product. We need UX experts within public health teams.

Waterfall project management. You may not have called your work in public health a ‘waterfall process’ but you certainly have been working this way: describe an agreed outcome, set targets, and start working towards the agreed goal. It can lock people into phases and silos – not surprising since it comes from production thinking and factories. It is just not very useful for digital development or for solving complex problems – these can be better solved with an Agile approach. Bureaucratic organizations tend to get addicted to waterfall as it gives the appearance of control (but does not always). Sounds familiar? Agile + Waterfall = culture clash unless carefully thought through.

Generation Z. Those born after 1995. These technological savants will be joining us soon! The future public health leaders.

5 comments

  1. Peter Bradley

    Marvellous. It's like the Enigma Code for digital.

    Link to this comment Reply
  2. Abrar Hamid

    Great stuff. I will refer my students to your website when teaching Systems Analysis

    Link to this comment Reply
  3. Simon Dixon

    Another one to add to the list:
    Progressive Web App: these use modern web capabilities to deliver an app-like user experience in a web browser. They allow all the basic functionality of native apps (e.g offline content or push notifications) but without the access restrictions and development/maintenance costs.

    Link to this comment Reply
  4. Julia Robson

    Great reference tool. Thank you

    Link to this comment Reply
  5. Tara Oduro-Amaniampong

    Great! Very informative and clear. Thanks

    Link to this comment Reply

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