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Digital and online symptom checkers and assessment services are used by patients seeking guidance about an urgent health problem. These services generally provide people with possible alternative diagnoses based on their reported symptoms and/or suggest a course of action [e.g. self-care, attend a general practitioner (GP) appointment or go to an emergency department (ED)].
In England, the NHS111 service provides assessment and triage by telephone for problems that are urgent but not classified as emergencies. The latest data from NHS England2 show that in April 2018 there were 1,338,253 calls to NHS111, which is an average of approximately 46,100 calls per day. Outcomes of these calls were that 12.1% of calls resulted in ambulances being despatched, 8.7% of patients who called were recommended to attend an ED, 60.7% of patients who called were recommended to attend primary care, 4.6% of patients who called were recommended to attend another service and 14% of patients who called were not recommended to attend another service (e.g. their condition was considered suitable for self-care).
NHS England is planning to introduce a digital platform for NHS111. This would include a possibility for patients to be referred to the NHS111 telephone service for further assessment.
A beta version of the service (referred to as ‘NHS111 Online’) is available at the following website: https://111.nhs.uk/ (accessed 1 June 2018). The ‘digital 111’ service is seen as key to reducing demand for the telephone 111 service, enabling resources to be redirected to support ‘integrated urgent and emergency care systems’ (contains public sector information licensed under the Open Government Licence v3.0 www.nationalarchives.gov.uk/doc/open-government-licence/version/3/), as outlined in the NHS Five Year Forward View3 and its 2017 update Next Steps on the NHS Five Year Forward View.4
It is thus hoped that a digital 111 platform will help to manage demand and increase efficiency in the urgent and emergency care system, complementing the agenda of locally based Sustainability and Transformation Partnerships. However, there is a risk of increasing demand, duplicating health-care contacts and providing advice that is not safe or clinically appropriate. For example, an evaluation of the NHS111 telephone service at four pilot sites and three control sites found that in its first year the service was not successful in reducing 999 emergency calls or in shifting patients from emergency to urgent care.5 A recent study of 23 symptom checker algorithms providing diagnostic and triage advice that would form the basis of a digital 111 platform found deficiencies in both their diagnostic capabilities and their triage capabilities.6
In 2017, NHS England carried out pilot evaluations of different systems in four regions of England.7 The evaluations aimed to assess whether or not digital/online triage was acceptable to users and connected them with appropriate clinical care.7 The full report from NHS England is not yet published at the time of writing this review. The objective of this systematic review was to inform further development of the proposed digital platform by summarising and critiquing the previous research in this area, from both the UK and overseas.