1. The ISABEL user survey Dr Jim Briggs Dr Tineke Fitch Healthcare Computing Group University of Portsmouth http://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 clinical decision-support system (Adult version since January 2005) History The ISABEL medical charity (Now also a UK & US-based company)

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

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

6. 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

7. 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

8. 2. User survey 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

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. Survey results 1 518 usable responses (12%) included high proportion of most frequent users 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

11. Survey results 2 Paediatric specialists used ISABEL slightly more frequently than non-specialists 28% vs 15% use it weekly or more 76% would use it more but for: time constraints (25% paed cons; 33% GP) lack of access to IT (16% paed; 9% others) 24% would not use it more: already use it as much as required

12. Survey results 3 37% of paediatric consultants and 21% of GPs said it was unsatisfactory and needed improvements Only 2% used it routinely; 61% used it in "some" cases; 35% used it in "difficult" cases 88% found it easy to use 70% were of the opinion that ISABEL assists in clinical management

13. Survey results 4 96% of users had computer access in their workplace 82% connected to Internet Paed cons had twice the access vs junior paeds (2.6 person/computer vs 5.8) Only 3% of paeds had computer next to patient compared with 37% of others 18% of paeds and 57% of others have access in same room as patient

14. Key observations Small number of devoted users Not just a tool for hospital doctors Website was not sufficiently useful or not sufficiently convenient for the vast majority of users Evidence that Internet access was ad hoc rather than established in workplace particularly in secondary care sector Not everyone wanted to use it more

15. Issues for DH To encourage use of ISABEL: improve professionals' access to IT (evidence of queuing) improve proximity of computers to patient make it part of clinical protocols note its usefulness as an educational tool adult version would be valuable

16. 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: jim.briggs@port.ac.uk