ISABEL: the use of a web-based clinical support system Dr Jim Briggs Dr Tineke Fitch University of Portsmouth, UK

Contents What is ISABEL? Our study Results Observations

What is ISABEL? Web-based paediatric clinical decision-support system History The ISABEL medical charity

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

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

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

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

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

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

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

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

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

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

Finally Acknowledge help of ISABEL team Financial support from Department of Health - Directorate of Research, Analysis and Information ISABEL: Our report: