ISABEL: the Use of a Web-based Clinical Support System Dr Jim Briggs Dr Tineke Fitch University of Portsmouth, UK

What is ISABEL? ISABEL [1] is a web-based clinical decision support system for use by healthcare professionals. The website is owned and has been developed by the ISABEL Medical Charity, a UK-registered charity. The project started as a result of a little girl called Isabel falling dangerously ill with complications resulting from chicken pox. She had to spend 4 weeks in intensive care to save her life because her serious condition was not recognised in time. As a result of this bad experience, Isabel's parents led an effort to develop a resource that could be used by healthcare professionals to assist in the diagnosis of children.

What is ISABEL? The core of is a clinical decision support system. Using proprietary pattern recognition software (Autonomy [2] ) to search standard paediatric textbooks, a differential diagnostic tool produces a list of up to 15 diagnoses to consider for any given set of clinical features.

What is ISABEL? The system has come to the attention of the Department of Health, which is examining its potential effectiveness in the wider clinical context and exploring options for promoting its wider use in the NHS. Our review was performed in two parts: log data analysis, and a users’ survey [1] ISABEL [Web Page]. Available at [2] Autonomy [Web Page]. Available at

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

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%) 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

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

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

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

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

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: