Why we are deprecating and then withdrawing the NHS Common User Interface

By Matt Edgar. 4 July 2019.

Today we’ve issued a notice to formally deprecate the NHS Common User Interface (CUI), a detailed but now outdated set of standards for designing user interfaces for healthcare computing systems.

We said we would do this in the Draft NHS Digital Standards Framework published last year.

The decision to deprecate was made by the Data Coordination Board and this notice explains what this means for anyone designing user interfaces for health:

• Information Standards Notice: Deprecation of ISB 1500 - 1508 (Common User Interface)

Deprecation means the standards will no longer receive further development, but can and should still be referred to until they are withdrawn.

Before withdrawing the standards, NHS Digital has committed to reviewing them to identify the elements which remain relevant to ensuring patient safety.

Good intentions

The intent behind the CUI was good, and the team who created it followed a rigorous user-centred design process. By standardising the design of key user interface elements, its creators hoped to improve patient safety and usability.

For example, the CUI included a template for a ‘patient banner' that showed key demographic information about a patient in a consistent format. Clinicians could use this to verify that they were looking at the records of the right patient.

The need for consistent, usable interfaces is as strong today as it was when the CUI was created. On my notebook I have this sticker, made by Dean, our lead designer for the NHS website: “Usability is a clinical safety issue”.

Changing times

In the past 10 years, the world of digital health has changed massively.

The CUI was created at a time when digital meant 4:3 ratio CRT monitors. Today, we’re designing for display on mobile devices, tablets, touchscreens, and even voice assistants.

Unfortunately, the CUI has not changed with the times. Its content has not been updated since the closure of NHS Connecting for Health in 2013 and is now hosted by the National Archives.

What’s more, the way we design and build digital services is different now.

We work in agile, user-centred ways to make sure that what we’re doing meets the needs of the people using our services. You can find out more about these methods in the Government Service Manual and the companion NHS digital service manual.

We have other standards to apply such as the Web Content Accessibility Guidelines (WCAG), the latest version of which will soon be mandatory for both websites and mobile apps across the public sector.

And we have other ways of promoting consistency such as freely sharing the open source code that we use to create NHS services, as we have with the NHS.UK Frontend Library. There is a growing community around this activity, inside NHS Digital, and across the wider health and care sector.

A new patient banner

For example, the NHS e-Referrals team found that their patient banner  wasn’t meeting accessibility and usability standards.

Using the NHS Frontend Library as a starting point, they tested some new header elements and used testing and accessibility guidelines to produce a version which works better for users.

Subsequently, members of the e-Referrals team have collaborated with colleagues working on the Summary Care Record application, which also displays patient information on a mobile device.

Each solution was researched in its own context, with the right sample of users, and on the devices they actually use. As with everything we do at NHS Digital, this took place under the appropriate clinical governance.

You can see the new components and patterns being discussed in the open on the service manual backlog.

Useful, usable and used

To bring about our vision of safe and intuitive systems that work well together, we need standards that are relevant to today’s designers and developers. The standards we mandate must be well maintained, straightforward to adopt and easy to assess services against.

While many people consider the CUI to be out of date and no longer refer to it, we’ve heard from others who see it referenced in contracts and are unsure if they should ask suppliers to follow it.

That’s why we’re deprecating the CUI by giving formal notice today. We plan to keep the data formats that are still relevant but to separate them from out-of-date assumptions about presentation.

NHS Digital will do this work in collaboration with NHSX, which has a new role in developing, agreeing and mandating clear standards for the use of technology in the NHS.

This blog was edited on 26 July 2019 to provide further clarification with regards to the deprecation and withdrawal process.