The National Diabetes Services Scheme (NDSS) Enhancement project will deliver outputs to support the effective and efficient management of the NDSS and improve access to the NDSS services and products for people with diabetes and their carers. The project consists of three major phases:

• Phase 1 – NDSS Central (Dynamics CRM 365)
• Phase 2 – NDSS Health Professional Portal
• Phase 3 – NDSS Health Registrants and Access Point Portal.

This report is for the Alpha assessment of Phase 2 - NDSS Health Professional Portal

Background

The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government and provides access to subsidised products and services needed for the self-management of diabetes. The NDSS supports people with diabetes by providing timely, reliable and affordable access to support services and products at subsidised costs

The NDSS is administered by Diabetes Australia (DA) through an agreement with the Department of Health and will cost $851 million over a four year period (2016 – 2020).

Registration with the NDSS is free and open to all Australians who are diagnosed with diabetes and certified as eligible to access the scheme.  NDSS support services are available through DA and NDSS Agents (Diabetes organisations) in each State and Territory. NDSS products are obtained through NDSS Access Points (community pharmacies) in all states and territories.  Persons registered with the Scheme can access subsidised products including: syringes and needles, blood glucose test strips, urine ketone test strips, and insulin pump consumables.

Diabetes Australia has been the administrator for all components of the NDSS since 1987.  The existing NDSS system, maintained by DA, is primarily a logistics system and has not been set up to capture supporting client level data regarding Support Services and engagement with the NDSS.  Support Services data is currently captured and stored in a variety of systems and formats at the State and Territory NDSS Agent and is not reported in a consistent manner to the Department of Health. Information on registrants’ access to services and support programs is limited and existing support systems do not provide the flexibility to meet emerging and future business needs.

Phase 2 of the project - the NDSS Health Professional Portal - will offer health professionals an online option for submitting an NDSS registration or product access change for a person with diabetes. The NDSS Health Professional Portal allows a person with diabetes to be quickly registered for the NDSS program and give them immediate access to a range of NDSS product and services.

Criterion 1: Understand user needs

The project team demonstrated an extensive engagement with users and understanding of user types and differences in user need across variant user groups.  The team approached 34 identified users and interviewed 28 users conducting eight site visits (12 participants) and ten teleconference interviews (16 participants) covering ACT, NSW, NT, QLD, SA, WA and VIC. Interviews were conducted by the Project Director, the Stakeholder Engagement Officer (SME), Stakeholder Support Officer, Business Analyst and UI/UX designer.

User research concentrated on Credentialed Diabetes Educators (CDEs) user group that accounts for about 10% of active* health professionals, but CDEs certify about 47% of all new registrations each year and were more willing to participate as diabetes is their primary, day-to day work responsibility. Though not all members of the team were able to attend interviews in person, some attended teleconferences and the results of the interviews were shared with all the members of the team, providing opportunities for all team members to build empathy and understanding of their users. The results from the user research were documented and user personas and user journey maps were discussed and shared in a team setting and user research findings have informed decision making on product improvements. A profile for each user type has been created and contains a brief description of how each user type interacts with the system, the functions they perform, their pain points with the current manual process, as well as the areas for automation and improvements.

The users for Phase 2 of the project are health care professionals such as GPs, Nurse Practitioners, CDEs, Endocrinologists, Practice nurses, Credentialed pharmacists and Aboriginal Health Practitioners. However, the project team also considered the registrants and their carers.

User research identified that larger tertiary diabetes centres prefer to prefill the patient contact details and diagnosis, as well as pre-certify forms for one on one appointments. However, larger tertiary diabetes centres see gestational diabetes patients in a group setting and spend limited time with patients on an individual basis which was an unexpected finding. The initial prototype of the online registration was implemented for a one on one setting, not a group setting. The team has a documented plan for ongoing user research and engagement, in particular for option to cater for a group setting and also into Phase 3 of the project. For example, information has been structured in a way that relevant screens may be presented to registrants without access to any medical information or records of other registrants.

Though the team performed well under this Criterion, they are encouraged to undertake further research to consider the experiences of users with diverse needs such as those of diverse cultural or linguistic backgrounds and those who may need assistance to interact digitally, in particular those registrants that may assist in completing a portion of the form online.

Criterion 2: Have a multidisciplinary team

The team is collaborative and positive, with a good mix of experience and skills in the areas of project management, business analysis, application development, technical architecture, user interface and user experience, and testing. The product owner is fully engaged and empowered with decisions being made at the correct level resulting in the decision making processes being quick and efficient. Senior executive support is available.

The team has well defined processes for knowledge sharing and on boarding of new team members. New starters get a walkthrough from project SMEs, peer reviews, sprint reviews and daily stand-ups. System design is documented and the team uses a range of collaboration tools such as Octane, SharePoint, and TRIM.

There was a good amount of sharing and cross-skilling apparent, with the product and delivery managers inviting experts from the wider department to support the team’s project work, such as the Security Team and Testing Team. The project team provided advice and assistance to other Departmental projects regarding the use of software products for the agile approach.  

The team is highly motivated, multi-disciplinary and performing very well in adhering to the Digital Service Standard. However, they are encouraged to develop a skill and experience matrix for the team members. This will be of assistance in identifying any potential skills gaps as the project moves into Phase 3.

Criterion 3: Agile and user-centric process

The project is effectively using agile/scrum processes and is aligning work appropriately. The project team is using 3 week sprints and demonstrated the use of agile tools such as Kanban charts, backlog-grooming, user story refinement, sprint-planning, daily stand-up, sprint reviews, and sprint retrospectives. Octane is used as an agile development, delivery and management tool.

The team shared documentation on issues identified during user research and solutions planned or executed during alpha. The team has developed a series of user journey maps and documented all user types. Users were involved in discussions regarding issues/progress so it is clear they are taking a user-centric design approach. The team has plans for further refinement of the online portal solution in line with user feedback and additional testing to be arranged with the remaining user cohorts.

The MVP is clearly documented and articulated as part of the features schedule tying directly to sprint schedules and delivery. Hypothesis statements and validating approaches have been captured as part of the confirmation process to ensure a user centric design can be delivered upon in the beta stage and future phases.

Criterion 4: Understand tools and systems

The team is re-using and leveraging a technology stack used successfully in other areas of Health. In particular, team is working with the IT Division (ITD) Commercial Management team to engage with the Whole of Government (WOG) contractor for the Microsoft cloud based SaaS products – D365, Azure SD, Azure Service Bus and Apps.

NDSS team also engaged with the department’s ITD Strategy and Governance Branch, Security and IT Services Branch to ensure products, services and licensing comply with Enterprise solutions, DTA, WOG and ISM standards.

Criterion 5: Make it secure

The team has developed a project security strategy providing a framework for the delivery of a secure NDSS solution. A privacy impact assessment is scheduled for completion in the near future.  It is expected that security accreditation of the NDSS HPP solution will be achieved by early 2019 and that the solution will be subject to a penetration test prior to its release.

Criterion 6: Consistent and responsive design

The UX/UI team specialist reviews functionality and adapts designs to improve usability. Interface components are styled using the Australian Government Design System to deliver consistent customer experience. Portal elements are optimised to suit both touch screen and desktop use and functional in all supported web browsers across desktop and mobile devices.

Interface is simple and has a clear flow, providing the user with clarity on their journey. Branding adheres to NDSS brand guidelines, creating a recognisable and consistent environment for the users.

User testing and observation of users is fed back into design.

Criterion 7: Use open standards and common platforms

The service is re-using and leveraging a technology stack used successfully in other areas of Health and other government departments.

Criterion 8: Make source code open

Project is reusing/sharing code and documentation from other projects within the Department of Health. The project is applying open standards and common platforms where this delivers a secure and acceptable solution.

Criterion 9: Make it accessible

The service will follow the standard Health governance process for ensuring adherence to WCAG 2.0 in both development and design protocols. Layout designed to improve keyboard and visual experience. Interface incorporates usability and accessibility standards set by the Digital Service Standard by utilising the Australian Government Design System. Content written in plain language. Accessibility testing is planned prior to the portal release.

Criterion 10: Test the service

The team has a comprehensive multi-layered test strategy in place. It covers usability, accessibility, unit (developers), system, and user acceptance testing. System will be tested from the perspective of each of the user groups identified through the user research phase. Performance testing, security and penetration testing are also planned.

Criterion 11: Measure performance

The team has a number of performance measurement targets in progress.

Criterion 12: Don’t forget the non-digital experience

The existing service channels (i.e. manual application forms and processes) will remain available for health professionals and registrants who have limited access to electronic transactions. This will support their continual engagement with the NDSS.

Criterion 13: Encourage everyone to use the digital service

Education and awareness strategies for the portal are planned and take-up targets are being finalised. In particular, targeted communications announcing the NDSS Portal and links for further information will be sent to key stakeholder groups, training will be provided for National Helpline operators and electronic FAQs and training modules accessible via NDSS and Agent websites will be provided.

The take-up strategy is currently being refined.

Recommendations

The assessor panel congratulates the service team on very good progress on, and adherence to the Digital Service Standard. The team is encouraged to:

• continue ongoing user research, especially with diverse users, which will help inform improvements and the future direction of the service
• perform additional user research for the remaining user cohorts as planned
• develop a skills and experience matrix for the team members to assist in identifying potential future skills gaps
• continue sharing their experiences and work practices across the department to build internal capability on implementing the Digital Service Standard.