ISABEL the use of a webbased clinical support

ISABEL: the use of a web-based clinical support system Dr Jim Briggs Dr Tineke Fitch University of Portsmouth, UK http: //www. disco. port. ac. uk/hcc

Contents n What is ISABEL? n Our study n Results n Observations

What is ISABEL? n www. isabel. org. uk n Web-based paediatric clinical decision-support system n History n The ISABEL medical charity

What does ISABEL provide? n Primarily: n Supported by: n Differential diagnosis n Text tool n Based on standard textbooks n Autonomy software n Annotated images n Practice guidelines n Experience

Background to the study n Brought to the attention of the UK Department of Health n DH considering: n wider adoption in the NHS n possibility of an adult version n DH commissioned two studies: n Clinical review n User survey

Objectives of our study n Determine the extent of use of ISABEL n Find out users' attitudes to it n Identify barriers to further deployment or development n Study performed in 2 parts n log data analysis n user survey

1. Log data analysis n Based on log data provided by the web hosting company n Conventional web server logs n showed number of hits, pages accessed, etc. n Login and user registration records n User identity and timestamp n Covered the period from July 2001 to December 2002

2. User survey n 24 -item questionnaire sent by email to all UKbased registered users (4436) n Covering letter from ISABEL team encouraging completion n Returns by post, email and fax n Survey addressed: n Profession / grade / n n n speciality Work setting and available IT equipment Familiarity with computers Frequency of use of ISABEL Evaluation of ISABEL Comments

Data analysis results n 7179 registered users n 46% only used it once n 72% no more than twice n 90% no more than 5 times n Core of 50 users n average >= 1 visit per week n Usage highest during "office hours" n Most usage (where identifiable) from UK n Detail often hidden by NHS firewalls

Survey results 1 n 518 usable responses (12%) n Of these: n 58% from paediatric specialists of whom about half were of consultant grade n rest were junior doctors or nurses n n 42% from other healthcare professionals n of whom 45% were General Practitioners

Survey results 2 n Paediatric specialists used ISABEL slightly more frequently than non-specialists n 76% would use it more but for time constraints and/or lack of access to IT n Most common reason for not using ISABEL more often: already use it as much as required n 37% of paediatric consultants and 21% of GPs say it is unsatisfactory at present and needs improvements n 88% found it easy to use n 70% are of the opinion that ISABEL assists in clinical management

Key observations n Small number of devoted users n Not just a tool for hospital doctors n Website is not sufficiently useful or not sufficiently convenient for the vast majority of users n Evidence that Internet access is ad hoc rather than established in workplace n Not everyone wants to use it more

Issues for DH n To encourage use of ISABEL: n improve professionals access to IT (evidence of queuing) n improve location of computers (only 3% of specialists have computer next to patient) n make it part of clinical protocols n useful as an educational tool n adult version would be valuable

Finally n Acknowledge help of ISABEL team n Financial support from Department of Health Directorate of Research, Analysis and Information n ISABEL: n http: //www. isabel. org. uk n Our report: n http: //www. disco. port. ac. uk/hcc/projects/ISABEL n Email: jim. briggs@port. ac. uk