NHS Direct Online Research Articles

Internet-based remote health self-checker symptom data as an adjuvant to a national syndromic surveillance system.

Syndromic surveillance is an innovative surveillance tool used to support national surveillance programmes. Recent advances in the use of internet-based health data have demonstrated the potential usefulness of these health data; however, there have been limited studies comparing these innovative health data to existing established syndromic surveillance systems. We conducted a retrospective observational study to assess the usefulness of a national internet-based 'symptom checker' service for use as a syndromic surveillance system. NHS Direct online data were extracted for 1 August 2012 to 1 July 2013; a time-series analysis on the symptom categories self-reported by online users was undertaken and compared to existing telehealth syndromic data. There were 3·37 million online users of the internet-based self-checker compared to 1·43 million callers to the telephone triage health service. There was a good correlation between the online and telephone triage data for a number of syndromic indicators including cold/flu, difficulty breathing and eye problems; however, online data appeared to provide additional early warning over telephone triage health data. This assessment has illustrated some potential benefit of using internet-based symptom-checker data and provides the basis for further investigating how these data can be incorporated into national syndromic surveillance programmes.

Seeking Health Information Online: Does Wikipedia Matter?

ObjectiveTo determine the significance of the English Wikipedia as a source of online health information. DesignThe authors measured Wikipedia's ranking on general Internet search engines by entering keywords from MedlinePlus, NHS Direct Online, and the National Organization of Rare Diseases as queries into search engine optimization software. We assessed whether article quality influenced this ranking. The authors tested whether traffic to Wikipedia coincided with epidemiological trends and news of emerging health concerns, and how it compares to MedlinePlus. MeasurementsCumulative incidence and average position of Wikipedia® compared to other Web sites among the first 20 results on general Internet search engines (Google®, Google UK®, Yahoo®, and MSN®), and page view statistics for selected Wikipedia articles and MedlinePlus pages. ResultsWikipedia ranked among the first ten results in 71–85% of search engines and keywords tested. Wikipedia surpassed MedlinePlus and NHS Direct Online (except for queries from the latter on Google UK), and ranked higher with quality articles. Wikipedia ranked highest for rare diseases, although its incidence in several categories decreased. Page views increased parallel to the occurrence of 20 seasonal disorders and news of three emerging health concerns. Wikipedia articles were viewed more often than MedlinePlus Topic (p = 0.001) but for MedlinePlus Encyclopedia pages, the trend was not significant (p = 0.07–0.10). ConclusionsBased on its search engine ranking and page view statistics, the English Wikipedia is a prominent source of online health information compared to the other online health information providers studied.

Health information for the consumer: NHS vs the BBC

PurposeThe purpose of this paper is to evaluate of the results of a survey which asked people where they went online for their health information, why and what success they had. The prime purpose of the questionnaire was to obtain information on the audience for health information web sites and to obtain feedback as to what they used online health sites for. The focus was on two major publicly funded health internet sites: NHS Direct Online and the BBC web site.Design/methodology/approachAn online survey was carried out with a population of internet users in the UK in the winter of 2004, yielding a sample of nearly 1,000 (923) people and a response rate of 4.4 per cent was achieved.FindingsThe survey identified that indeed both sites were well used although their users were very different in terms of how they arrived at each site and in terms of what they were looking for. Outcomes resulting from using the sites are discussed and compared. Though outcomes differed between NHS Direct Online and the BBC the data suggest that the national sites were not meeting the demanding information needs of some users.Originality/valueIt is the first time that two publicly funded national sites that aim to provide the UK population with health information are compared.

Shaping sands, shifting services

The unusually-titledHealthComputing 2005 (HC2005) conference turned out to be apposite in the event: thosewhohave beenworking in the health informatics environment over the last year or so will have many times felt as though they were trying to build sandcastles in a howling gale, while the shape of services (both healthcare and informatics) changed with what is coming to be the expected regularity. In primary care over the last few years, those changes have included service reconfiguration to encompass the impact of walk-in centres, out-of-hours services, NHS Direct and NHS Direct Online, Shifting the Balance of Power, the New GMS Contract, Agenda for Change, practice-based commissioning, and the National Programme for IT (now known as NHS Connecting for Health). The opening keynote speaker for the conference was then most appropriately chosen: Professor Nancy Lorenzi is internationally renowned for her expertise and publications on the management of change in the healthcare environment. Her address on transformational change reinforced the point known tomany but heeded by few that success is 80% dependent on the social and political environment, and only 20% on the hardware and software – somemight even argue that it should be 90% and 10%, respectively! She also pointed out that motivation can make even a poor system work effectively, but a perfect system will fail if the users are disempowered or unmotivated. And the introduction of IT cannot solve organisational problems alone. She proceeded to give some very practical advice on strategies for effecting successful change – none of which is new, but without which failure is inevitable: clear objectives must be set and communicated, and a strategic plan formulated; people at all levels must feel ownership of the plan; attention must be paid to the organisational culture (‘culture eats strategy for breakfast’) and how it supports (or not) the changes being implemented; develop leaders and champions for the change (not just those in traditional positions of power); be patient and resist false urgency; stay involved, keep communicating; evaluate; seek feedback (and act on it); plan ahead for the next phase of change. Dr Peter Homa, Chief Executive, St George’s Healthcare NHS Trust, followed with an inspiring and amusing talk on dealing with change; his most striking points for me were the need to have a shared purpose and broad objectives focused on improving patient care, the risks of automating inefficient and ineffective processes, and the necessity to empower skilled change agents. Further wisdom pointed out that a broad vision, not a detailed blueprint, would produce more flexible and effective change, as would the encouragement of strong lateral relations and networking across boundaries, together with commitment to individuals’ development, with a focus on skill not status. Again, the emphasis was on leadership styles, communication, and the importance of organisational culture and power. He used a number of notable quotations, some unattributed:

An evaluation of the NHS Direct online health information e‐mail enquiry service

PurposeTo judge the quality of health information provided to the users of the NHS Direct online enquiry service.Design/methodology/approachAn examination of available online tools was necessary to enable the development of a quality framework appropriate for the study. The checklist developed from this process provided a method of judging a specific web site's quality level. Readability levels of web sites were measured using the Flesch‐Kincaid scale. Two case studies were conducted to examine consistency of responses, and in order to measure user satisfaction questionnaires were distributed.FindingsResults from the checklist indicated that the majority of health information sent on to users of the service was of adequate or excellent quality. The readability levels of information promoted by the NHS Direct Online enquiry service are at levels higher than is recommended in the literature. The case studies implied that the criteria used by the NHS in composing responses to enquiries is not always consistent and may need streamlining. Despite this, 97 per cent of respondents were happy with the information sent to them. A combination of user satisfaction and referral to adequate or excellent quality health web sites suggests that the NHS is providing a good quality information service to the British public.Research limitations/implicationsIt is difficult to draw reliable conclusions from the small sample size employed in this study. It is also unfortunate that the respondents could not be interviewed or observed as they submitted their enquiry and while they examined web pages. The checklist developed to measure web site quality could, in itself, bring limitations, no weighting factors were employed when comparing criteria and the researcher felt that some of the criteria were hard to judge in practice.Practical implicationsThe NHS need to undertake some streamlining of their e‐mail enquiry service so that all the web sites it promotes contain health information that is at a good or excellent quality level.Originality/valueExamination of a practical health service which purports to help improve the quality of NHS health provision.

Assessing the Quality of Internet Health Information Using DISCERN

OBJECTIVE: This study was conducted to evaluate the quality of health information on the internet using DISCERN. METHODS: Breast cancer, asthma, depression, obesity were selected to be the tracer conditions of the health information. To collect information about these 4 tracer conditions, we first select top 9 popular Korean websites which provide health information in January 2004. Nine websites include 6 commercial, 3 hospital. To compare quality of internet health information provided by Korean public institute and other countries', we select Healthguide in Korea, MEDLINEplus in USA and NHS direct online in UK. Overall, a total of 45 heath information provided by 10 Korean, 2 other countries' websites were evaluated by two nurses independently using DISCERN. DISCERN is a heath information quality assessment instrument consists of sixteen five-point- scale item questionnaire. The score was compared between Korean commercial and hospital websites and between Korean public institute's website and those of USA and UK. RESULTS: Korean internet health information scored 2.0 for overall quality score. Internet health information of commercial websites scored 1.8 for overall quality score that was lower than hospital websites(2.4). Internet health information provided by Korean public institute scored 3.0 compared 3.3(MEDLINEplus) and 3.8(NHS direct online). CONCLUSION: Internet health information in Korea hardly meets DISCERN standard that means Korean health information have a problem in quality. Especially, Internet health information of commercial websites needs relatively urgent improvement in quality.

Health information appraised for quality.

This article examines key issues around the quality and availability of health information, and introduces a range of initiatives in the UK which support the quality agenda. These initiatives share aims both to assure the quality of heath information and to make this information available to the public.

Health information on the Internet: a qualitative study of NHS Direct Online users

Examines the way the general public exploits the Internet for health information, the motives behind usage, attitudes towards issues such as quality concerns, and the extent to which Internet interventions affect the doctor‐patient relationship. Although a questionnaire survey was used (posted on the NHS Direct Web site), the questions asked were open, and invited free‐text “qualitative” answers. This method was a success in terms of the amount and richness of the data accrued. Results suggested that the Internet is exploited in a wide variety of ways, by users acting in a number of roles – patient, intermediary or professional. Some health professionals are now so comfortable with the Internet that they encourage Internet usage by their patients. Lay users demonstrated a high level of understanding of issues raised, and showed a (healthy?) scepticism regarding the information provided. Many users felt that their consultations with doctors had been enriched by Internet‐acquired information.

News from NeLH

September saw the launch of public access to the Cochrane Library and Clinical Evidence in England. This is an important step to providing a common knowledge base for all, a move which is supported in the Department of Health’s response to the Bristol Inquiry . Available through the NeLH, the Cochrane Library and Clinical Evidence provide in-depth information that ‘expert’ and well-informed patients may find useful although of course will not replace the need for patientfocused services such as NHS Direct and NHS Direct Online . The publishers use geolocation software, which for most people removes the need to enter a username and password. Users can still register for an individual username and password, to create their own account, should they need to save searches.

NHS Direct Online: its users and their concerns

Over a period of over a year more than 3000 people responded to an online questionnaire that was posted on the NHS Direct Online web site (www.nhsdirect.nhs.uk). The prime purpose of the questionnaire was to obtain information on the audience that the web site attracted and to obtain feedback as to what they thought of the site in order to inform future development. This was particularly important as the site was developed quickly with a minimum of user input. Data collected included: the age, gender, institutional affiliation and geographical origin of users; how users found out about the site; sections of the site visited; whether they had used it before; whether they had used the NHS Direct telephone service; and what developments they would like to see. The study provides a rich array of user comment with regard to health information on the web. As a direct result of the knowledge gained through the questionnaire, the site was comprehensively redesigned in 2001.

NHS Direct Online: its users and their concerns

Over a period of over a year more than 3000 people responded to an online questionnaire that was posted on the NHS Direct Online web site (www.nhsdirect.nhs.uk). The prime purpose of the questionnaire was to obtain information on the audience that the web site attracted and to obtain feedback as to what they thought of the site in order to inform future development. This was particularly important as the site was developed quickly with a minimum of user input. Data collected included: the age, gender, institutional affiliation and geographical origin of users; how users found out about the site; sections of the site visited; whether they had used it before; whether they had used the NHS Direct telephone service; and what developments they would like to see. The study provides a rich array of user comment with regard to health information on the web. As a direct result of the knowledge gained through the questionnaire, the site was comprehensively redesigned in 2001.

Evaluating metrics for comparing the use of web sites: a case study of two consumer health web sites

Use is plainly an important characteristic in determining the success or otherwise of a web site and in making comparisons between sites. The source of most use data are the web logs that record user activity on a real-time and continuous basis. There is much demand from sponsors, site owners and marketing departments for this information. The authors examine the kinds of comparison that can be made, the performance of the respective metrics in comparing two sites - something that is still relatively rare - and discuss the methodological problems associated with making such comparisons. Two consumer health sites - NHS Direct Online and SurgeryDoor - are compared. Data were collected for the month of November 2000. During this period the two sites were visited by more than 60,000 people who recorded more than 1 million page views. The paper shows that the most widely used and heralded metric of use, page views (impressions) is heavily dependent on site architecture and this causes difficulties in comparing the performance of sites.

Use of the Internet by patients: not a threat to nursing, but an opportunity?

The Internet poses numerous challenges for health care professionals. A significant one is the way in which patients, clients and carers now have access to large amounts of unfiltered, specialized health information, much of which was, hitherto, solely the province of the professionals. The specific problems that this poses, in terms of the effect that it might have on the therapeutic relationship, are discussed, along with some of the proposed solutions, such as the National Electronic Library for Health initiative and NHS Direct Online. Since this change is inevitable, it is recommended that nurses should seek to build on their role as educators of patients and carers. One of the ways in which they can do this is by guiding patients’ and carers’ use of the Internet, and helping them to evaluate the information that they find.

Innovations online

Innovations online

NHS Direct Online - hypochondriac's charter?

The arrival of the NHS Direct Online site, http://www.nhsdirect.nhs.uk/ , is the most convincing evidence yet of the web's credibility within government. This resource logically augments NHS Direct, the round-the-clock nurse led service, launched last April. A brave step; a legitimate NHS innovation.

NHS direct online service a hit

NHS direct online service a hit