ISABEL: The Use of a Web-Based Paediatric Clinical Support System

1. ISABEL: The Use of a Web-Based Paediatric Clinical Support System Dr Tineke Fitch Dr Jim Briggs University of Portsmouth, UKhttp://www.disco.port.ac.uk/hcc

2. Contents • What is ISABEL? • Our study. • Results. • Observations.

3. What is ISABEL? • www.isabel.org.uk • Web-based paediatric clinicaldecision-support system. • History / ISABEL medical charity

4. Primarily: Differential Diagnosis Tool; based on standard textbooks; Autonomy software. Supported by: text; annotated images; practice guidelines; experience. What does ISABEL provide?

5. What is ISABEL?

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

7. 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.

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

9. 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

10. 24-item questionnaire sent by email to all UK-based registered users (4436). Covering letter from ISABEL team encouraging completion. Returns by post, email 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. 2. User survey

11. Survey results • 518 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.

12. Survey results • 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.

13. Key observations Small number of devoted users … “Isabel is charmingly intuitive and easy to use. It works unlike any other medical search engine I have ever used, and is a wonderful resource. I have used it as a diagnostic tool, and also when I want to look up a topic in clinic- it acts as an 'online Nelson'. It does occasionally turn up inappropriate results, but generally I find it helps me to think laterally on a problem, and I have recommended Isabel to a number of colleagues.” (Source: The ISABEL User Survey, 2003)

14. Key observations Not just a tool for hospital doctors … “I first discovered ISABEL when undertaking my HV training this year. Interestingly, none of the HVs I was working with had ever heard of or used ISABEL. It was a RNLD colleague of mine who told me about it and initially I used it to alleviate my own personal anxieties about my son's health. Since then I have used it as a reference and information gathering tool and have told the HVs about it.” (Source: The ISABEL User Survey, 2003)

15. Key observations Website is not sufficiently useful or not sufficiently convenient for the vast majority of users … “I am so busy at work that accessing the internet for ISABEL never seems possible or appropriate, although I know that I would benefit from looking things up both for my knowledge and the care given to the child and family.” “Layout cumbersome.” (Source: The ISABEL User Survey, 2003)

16. Key observations Evidence that Internet access is ad hoc rather than established in workplace … “Very useful but I have limited access to the computer.” “Is helpful, but accessibility is a problem.” “Limited access to IT in the clinical environment.” “Internet connection times are often quite slow at work.” (Source: The ISABEL User Survey, 2003)

17. Key observations Not everyone wants to use it more … “Use it as much as I need to (a few times a week).” “No need to use more often.” “Not always needed.” (Source: The ISABEL User Survey, 2003)

18. 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.

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