Centre for Healthcare Modelling and Informatics
ISABEL
| Principal investigators | Jim Briggs and Tineke Fitch |
| Date | September 2002 to May 2003 |
| Funding | £9,500 from the Department of Health |
| Links |
Background
ISABEL is a web-based clinical decision support system for use by healthcare professionals.
The system was brought 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. The project, commissioned by the Department of Health, reviewed the existing use of ISABEL.
Executive Summary
ISABEL is a web-based clinical decision support system for use by healthcare professionals. 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. This report, commissioned by the Department of Health, sets out to review the existing use of ISABEL.
The review was performed in two parts:
- To find out how many people actually use ISABEL, we used log data recorded
by the website to analyse usage.
The web survey shows that the ISABEL website is used by a core of regular users, 50 or so of whom use it on average once a week, another 150 who use it every 2 to 3 weeks and a further 600 or so who have used it more than a handful of times. However, 90% of its registered users have used it 5 or fewer times, and 46% of its users only once. Patterns of usage show that it is most used during the normal working day, with reduced usage out of normal hours and at weekends.
Most usage (where identifiable) is from the UK, with at least a quarter of accesses coming from somewhere within the NHS, but there is also a significant amount of access via Internet service providers. Detailed breakdown of where in the NHS access is coming from is frustrated by the anonymisation of sources by the NHSnet to Internet gateways.
- To find out user's attitudes to ISABEL, and to identify impediments to
its development, we did a survey of registered website users. Our survey achieved
an 11% response rate from those to whom it was sent, but, we suspect, includes
a very high proportion of the regular users of ISABEL. 58% of respondents
were paediatric specialists, but the fact that 42% were not indicates that
people in a wide variety of health service roles use ISABEL.
As one might expect, paediatric specialists use ISABEL slightly more frequently than non-specialists, but very few people use it more often than weekly. Three-quarters say they would use it more but for time constraints and lack of access to information technology. For those who would not use ISABEL more often, the main reason is that they use ISABEL as much as they require. However, one-third of paediatric consultants and one-fifth of General Practitioners say ISABEL is unsatisfactory in its present form and improvements are needed.
Half the respondents use ISABEL “in some cases”, with one-third of respondents only using ISABEL in difficult cases. Only about 2% use ISABEL in all cases presented. The aspects of ISABEL that are particularly liked are the differential diagnostic tool and the guidelines, and approximately two-thirds are of the opinion that ISABEL assists in clinical management.
Together these suggest strongly that there is a small and very supportive community of devotees, including those who are involved in the development of the site, but that the website is either not sufficiently useful or not sufficiently convenient for the vast majority of users who have tried it out. The reasons for the latter are largely systemic to the NHS and the way it delivers its services, and would require considerable resources to make more Internet-connected computers available, and to give staff more time and opportunity to use them.