The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation

OBJECTIVES: To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting. DESIGN: Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice. SETTING: The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot. PARTICIPANTS: General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot. MAIN OUTCOME MEASURES: General practitioners’ views, experiences and usage of the system. RESULTS: Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form. CONCLUSIONS: Isabel was of limited utility in this short pilot study and may need further modification for use in general practice.