www.sxt.org.uk - a platform tailor-made for sexual and reproductive healthcare providers

www.sxt.org.uk is the only provider-run database of sexual and reproductive healthcare. We have used our own on-the-job experience to create a platform which meets the needs of the people who work in this area of healthcare, tackles some of the day to day frustrations they face, and is easy for them to use and incorporate into their management practices. Here's how we've done it ..

Four years ago, we launched SXT as a simple SMS service; however, the lack of flexibility with text messages, especially when compared to smartphones, pushed us into developing a web service, which then became mobile friendly for clients in August 2013. In February 2015, we turned www.sxt.org.uk into a mobile friendly website for providers too.

The information technology hurdle

The problem of out-of-date internet browsers on computers across the NHS has been one of the biggest barriers to providers joining and using www.sxt.org.uk effectively.  Those who signed up to and used the site early had to use their computer at home to do so because their work software did't function properly.  In 2012 we used a Google chrome patch to try and make the site work on Internet Explorer 6 but few members of staff would download it because they thought that they would need administrator rights.  Internet Explorer 7 is better and so are early versions of Firefox but still www.sxt.org.uk does not look its best on these older browsers.  

Going mobile means that staff can use the computers that they carry around in their pocket to bypass the limitations of their computers at work.  The first step for all providers is to see if their service has already been uploaded to www.sxt.org.uk from NHS Choices or other databases.  The minute-long video below shows the simple steps to check our database.  If you are already on the website then please claim your service so that you can edit your hours of operation, services and profile.  If you are not, then you will see the simple steps to register and join.

Registering in www.sxt.org.uk

The Time Barrier

If you work in a busy service it might, at first, be difficult to see the benefit of taking the time to join www.sxt.org.uk.   After all, services already have a plethora of requests from commissioners, NHS bodies and other organisations (GMFA, THT, NAT and others) asking for a paper or electronic copy of the hours of operation, services, the types of clients being seen ... so why on earth should you join another information service?  But www.sxt.org.uk is not just another information service asking for the same, it is the chance to stop all the duplication and sharing of partial information about provision described above.

www.sxt.org.uk has been designed for providers to simply and accurately capture the details of their service.  Once they have been added, your details are visible not just to clients, but to all the other organisations requesting it.  Upload the data just once, so that it can be used many times, without you wasting time repeating the task.  It's simple to update your details, and this information can be shared either as a print out or via the SXT application programming interface that enables the database to share service information in real-time.

It takes less than a minute to register with SXT, another minute to apply to add a provider or outreach venue (see first video below) and less than 20 minutes to add details for a complex service and go live (see second video below).

Entering provider details on www.sxt.org.uk

Going live on www.sxt.org.uk

Keeping up to date

The mobile version of www.sxt.org.uk is now a super quick way to keep up to date.  Once you log in to www.sxt.org.uk on your mobile phone you can add the web page to your home screen.  Your mobile phone will remember the login details and consequently you will be able to see your service(s) with a touch of one icon.  As you can see from the video above it is as simple as checking a box to add a service, change hours of service or close for a day.

Enough already

Some providers may have concerns that marketing services on www.sxt.org.uk will attract more clients, when they are already having difficulty seeing the patients who currently attend.  Many services see patients with a diverse set of needs and a sizable fraction could be seen at another time or by another provider.

Equitable access is the aspiration of all providers; however, there are some patients who need to take priority because they require time sensitive services (such as emergency contraception or PEP), they are under 16 years of age or they have painful symptoms (e.g. the first episode of anogenital herpes).  As a health care system we need to ensure that we match capacity with demand to meet the needs described above. The best way to do this is to ensure that patients know which local services can meet their needs.  It is a system failure when patients who want a simple test wait hours and bottle neck around a service, making it difficult for a patient who needs a priority service to be seen.

www.sxt.org.uk has been designed for all providers of sexual & reproductive health services.  It does not matter if the service is online, a 100 hour pharmacy, a once a week outreach clinic or a seven day a week university hospital provider, www.sxt.org.uk meets needs across the network of provision.  It is only by communicating all services effectively to patients that we can distribute the work appropriately and optimize access to services. If you agree, and want to support our work, please visit www.sxt.org.uk and join.

What www.sxt.org.uk can do for clients, providers, commissioners and public health

SXT Health CIC is a social enterprise with a mission to improve access to sexual & reproductive health services. It has created www.sxt.org.uk - a mobile enabled website with a lot to offer to clients, providers, commissioners and pubic health.

Clients

www.sxt.org.uk has been designed first and foremost for clients - to help them find the right health service in the right place at the right time.  

The website works on all machines regardless of their screen size, and, thanks to responsive programming, it also works on mobile phones without the client needing to download an App.  

It is possible for the client to share pages from the website by email or SMS to, for example, inform a partner of available services. This can be done anonymously if the client wishes. Finally, there is a slide out feedback form so that clients can score the SXT service. This is currently completed by 8.5% of clients and 81% give a score of eight or more out of ten.

Providers

Changes have been made to the ‘back end’ of the website to help providers overcome some of the IT difficulties they may encounter at work, e.g. with older internet browsers.  Firstly, providers can sign up and edit their SXT pages, quickly and simply, on a smartphone.  

Providers can use their page on www.sxt.org.uk as a flexible advert, giving up to the minute information on opening times, services available, how/whether to book, and how best to travel to them. They can give different staff management rights over the page. And they can access analytics on how/why their services are being used, as well as feedback from clients.

Commissioners

It is difficult to appreciate where there are gaps in service and yet this information is key to optimize commissioning.  Gap analysis is available in real-time within www.sxt.org.uk, so that commissioners can view client use and providers chosen, with an oversight of provision that can be filtered by service, hours of operation and location.  

The impact of targeted marketing can be visualized in www.sxt.org.uk, where it is possible to see usage for a specific location and providers chosen, to determine client behaviour.  Like for providers, this information can be downloaded in formats that support analysis in separate software to inform and develop future programs.

Public health

This is a confidential service for all users, but it is possible to, anonymously, follow the client's journey through the website - from digital public health advert, to finding a provider, right through to whether they received a service, which they can rate with a simple thumbs up | thumbs down.  

The anonymous digital end-to-end tracking makes it possible for the first time to calculate an objective return on investment for public health marketing campaigns.

To fins out more, please visit www.sxt.org.uk, or watch this 5 minute film.

SXT - Why it was created, what we do, and how it has been achieved.

Why?

SXT Health CIC is a social enterprise with a mission to improve access to sexual & reproductive health services.  It was formed to meet the needs of clients, providers and commissioners and its goal is to optimise the relationship between capacity and demand.  

What?

www.sxt.org.uk is a mobile enabled website which guides clients to the right service in the right place at the right time.  Providers simply control their details within the database and www.sxt.org.uk translates this for clients so that they can act upon accurate information.  Commissioners are provided with a real-time gap analysis to support their development of the service.

The providers on www.sxt.org.uk have come from two main sources:

1. Providers signing up to www.sxt.org.uk and adding their services (n>300) [SXT verified]

2. Uploaded from other online databases (n>2000) - these services can be claimed by the provider

The provider has the ability to edit all the information about their service to ensure that they are accurately represented on www.sxt.org.uk.  As soon as changes are made they are live for clients to see.  All the information provided to clients is sourced from NHS Choices, the Family Planning Association and other reputable sources.

www.sxt.org.uk is as good as the data it holds and providers are encouraged to claim a service or register for free today to support the SXT mission

When?

The key events on the timelines have been:

• The idea was conceived and the community interest company was formed 2009
• The website & SMS engine started in January 2011
• A client facing mobile friendly version of www.sxt.org.uk was released August 2013
• The slide out feedback form was introduced at this time too (8.5% of clients who chose a single service give feedback and 81% give a score that is eight or more out of ten)
• A login for commissioners was developed in October 2014
• Providers were given access to a mobile friendly version of www.sxt.org.uk in February 2015

How?

To date SXT has been funded by the generous grants from:

• UnLtd / 4iP in July 2009
• Guy’s & St Thomas’ Charity in August 2010 & 2013

In November 2014 Big Issue Invest awarded SXT a corporate social venturing loan to build up the service.

The business model of SXT is to deliver digital public health marketing packages to raise awareness and improve access to services.

All money raised by the community interest company will be used to pay for its services and any surplus reinvested into the SXT mission.

If you are a provider and would like to support SXT’s mission please visit www.sxt.org.uk or watch this 1 minute video on how to join.

Return on investment - SXT is looking for partners to run highly effective prevention campaigns

Return on investment (ROI) is key for all the stakeholders in health care delivery.

Most ROI calculations are taken from the perspective of costs to the NHS

It has been estimated that for every pound spent on contraception £11 is saved by the NHS.

A range of ROIs has recently been published by the King's Fund and Local Government in their publication 'Making the case for public interventions'

SXT has just run a campaign to help clients find access to post exposure prophylaxis (PEP) which if taken after sexual exposure to HIV can reduce transmission of the potentially fatal virus.

It has been estimated that PEP needs to be given to 217 high risk exposures to prevent one person contracting HIV whilst the lifetime cost of HIV to the NHS has been estimated to be £320,000.

In the recent Google Adword campaign run in London, Brighton & Manchester 43 clients used SXT to find PEP.  Using very strict criteria to estimate the cost of this campaign it has been estimated that for every pound spent on this campaign £2 would be saved by the NHS.

This figure includes the costs of attending the clinic and medications whilst the cost of targeted Google Adword advertising represents less than 1% of the total cost to prevent one infection.

SXT is now looking for partners to pay for prevention programs that have the following features:

1.Demonstrate a clear return on investment

2.Utilize the power of digital public health marketing tools

3.Support providers to engage with SXT and clearly map their services so that clients can find the right service in the right place at the right time

4.Optimize the delivery of time sensitive services that have a significant public health value

A summary & update of SXT (www.sxt.org.uk)

Why was SXT formed?

The mission of SXT is to support access to sexual & reproductive health services.   The drivers to improve access are one person being diagnosed with HIV every 90 minutes in England & over half being diagnosed after they should have started treatment, half of all pregnancies being unplanned, syphilis infections the highest since the 1950’s, gonorrhoea becoming more difficult to treat, one third of women having an abortion had had one previously and 85,000 serious sexual assaults a year (http://bit.ly/W0CoNt).   

The importance of access is clear for time sensitive services, such as post exposure prophylaxis following sexual exposure [to reduce the risk of contracting HIV (PEP)], emergency contraception (EC) or sexual assault but it is also essential for patients who are symptomatic (e.g. first episode of anogenital herpes) and need prompt access to treatment and relief.  The detailed information within SXT reduces time wasting for patients and services because it reduces inappropriate referrals (e.g. the oral EC recommend depends upon the number of hours since unprotected sex).  In addition, SXT supports the ever-changing number of sexual & reproductive health services by allowing providers to edit and control their web presence as well as review activity and see why clients have selected their service.

What is SXT?

SXT (www.sxt.org.uk) is a free & anonymous platform for clients to find the right service in the right place at the right time as well as a powerful public health marketing tool for providers & commissioners.  The latest upgrade in August 2013 made it possible to upload providers from other databases, share the SXT service data with other web services and clients plus capture feedback.  There are currently over 2500 providers in SXT and this includes the British Association of Sexual Health and HIV clinics, all out of hours PEP providers (A&E services), UK sexual assault referral centres, HIV testing centres and GPs in England.  Fourteen percent of SXT users give feedback on the clinic locator service and 85% give a score of eight or more out of ten.

How SXT works for clients and providers?

The best way to see how SXT works for clients is to go onto the website and try it for yourself.  SXT has been designed to work on SMS, mobile and web.  All the information fits within a mobile phone text message and SXT strives to limit the digital divide to access information until there is near universal smart phone adoption.  Everything on the website & SMS responses can be edited or changed and the decision trees adapted.  If users have ideas or suggestions they can send it to feedback@sxt.org.uk so that the service can continually improve.   Providers can register or claim an uploaded service via the home page and it takes minutes to ensure that the service is up to date.

AdTags - converting an unmet to a met need

The first port of call for most people looking for information is Google.   Based on this reality, SXT ran a digital public health marketing campaigns last summer (see 05/08/13 blog post) using Google Adwords over six weeks across London.  During this time there were over 250,000 impressions, 864 clicks leading to 246 SXT clients who chose 163 specific providers [sexual health clinics, community services, GPs and pharmacies] for a one of four advertised services [Emergency contraception, STI testing, Contraception and Post Exposure Prophylaxis].

What was satisfying about the Google Adword approach was that it converted an unmet need in a Google search into a met need using SXT.  Assuming that every client who chose a provider in SXT actually visitied that venue then the return on investment was estimated to be £2.51 spent on Google Adwords for every provider chosen.  As impressive as this data is, SXT was keen to be there when an unmet need was identified in the real world and that is why it started to work with Connecthings (www.adtag.fr).   An AdTag is a 10 x 10 adhesive tag that can be seen from the photograph below.

The AdTag is stuck outside a clinic (for use when the clinic is closed), on a reception desk (for when a patient is turned away) or behind a toilet door for discreet use on a hospital ward or in a social venue.  The top left part of the AdTag advertises the service whilst the upper right area gives the website and SMS number for those clients who do not have a smart phone.  The QR (2D barcode) is for iPhone access whilst the Near Field Communication (NFC) section takes the Android user to the landing page when their phone is held over the AdTag.

The first weekend an AdTag was installed in a social venue frequented predominantly by men who have sex with men a user was directed to SXT and then used the risk checking function of the site to identify that he needed post exposure prophylaxis to prevent HIV exposure and finally chose a venue providing this service.  The AdTag connection to SXT made it possible to convert an unmet into a met real world need.  If HIV transmission was prevented in this person, by early access to this time sensitive service, then it would have saved the NHS over £300,000 in lifetime costs.

Use of AdTags and SXT is confidential; however, both services have powerful analtyical tools to understand usage.  For example, every AdTag is geographicallly located so that when a connection is made this can mapped.  When SXT is used to provide information and locate a local service it is also possible to map the chosen service if one is selected by the client.  The two distinct services can be linked by the date & time of usage and the referral details.

Over the last week there have been seven unique connections.  Four were at a pharmacy reception, one outside a clinic and two from AdTags placed in toilets; one on an antenatal ward and the other in a social venue.   SXT plans to continue with this analysis and is currently looking for sponsors to support and build upon this novel way to assist individuals with an unmet need.

Breaking the silence: the role of a slide-out feedback form to capture user experience

The challenge to capture feedback

Accurate information about service provision is important for patients to decide which provider to attend.  SXT (www.sxt.org.uk) was formed in 2012 and over 3000 clients have been successfully directed to a local provider offering the service they require.  However, despite adding a hyperlink to a webform for feedback less than a dozen individuals elected to leave their thoughts.  Feedback is a challenge to capture across all web-based services (e.g. TripAdvisor 2%, I want great care 25%*).  We therefore tested if the introduction of a slide-out feedback form, appearing three seconds after the client viewed a single provider page, would engage users and determine if they found the SXT service useful.  

Developing a new approach

Over the summer months in 2013 the website was re-designed (v3.0) and made responsive so that it adapts to any device – computer, phone & tablet.  During this development a slide-out feedback form was added asking the question ‘Did you find this service useful?  This form gives the option to score from 10 (very useful) to 1 (not useful) using radio buttons and a comment box is available for any text.  The new site went live on the 5^th August 2013 and the database records details of the date, time, postcode, service requested, local providers displayed, the provider selected, feedback score and comment.  The design and development of the website was done by Matthew Ford, Laura Paplauskaite & Michael Wallace (www.bitzesty.com)

What was the result?

Over six months a total of 683 clients looked for information or a service and 451 (66%) chose a specific provider and the slide-out feedback form was displayed.  A total of 67 (15%) clients left a score and these are shown on the table below.  The provider types chosen by clients giving feedback were 15 genitourinary medicine clinics, five sexual reproductive health clinics, five third sector clinics, four general practices, two sexual assault referral centres and one pharmacy. Only three clients wrote text with their feedback. The majority of clients found the service useful with 85% giving a response of eight or more out of ten.

Device used	Did you find this service useful? [Score 1 – 10]					Total
	1	7	8	9	10
Phone & Tablet	0	1	5	3	26	35
Computer	5	4	6	3	14	32
Total	5	5	11	6	40	67

What's next?

The slide-out feedback form has enabled SXT to engage clients and the responses to date support its utility to identify local services.  Further work will include placement of slide-out feedback form(s) on other pages of the website to determine the utility of the information services provided.

* Personal communication Dr Neil Bacon (Founder of I want great care www.iwgc.org)