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

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

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

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

5. 5 What is ISABEL?

6. 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. 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. 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. 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. 10 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.

11. 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. 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. 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. 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. 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. 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. 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. 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. 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.uktineke.fitch@port.ac.ukjim.briggs@port.ac.uk