Beld, Marieke S.

Brandenburg, Bart

Gemert-Pijnen, Julia E.W.C. van

Kelders, Saskia M.

Nijland, Nicol

Seydel, Erwin R.

Theune, Mariët

English

van Gemert-Pijnen, Julia E.W.C.

Theune, Mariet

University of Twente Research Information

Medicine 2.0.’08Poster 5Saskia M. Kelders, University of Twente; Nicol Nijland, University of Twente; Marieke S. Beld, University of Twente; Julia E.W.C. Van Gemert-Pijnen, University of Twente; Mariët Theune, University of Twente; Bart Brandenburg, Medicinfo; Erwin R. Seydel, University of TwenteUsing usability-tests to improve language match of a web-based system for digital triage in primary careBackground: Previous research showed that health care  consumers  favor  web-based  communication systems to control their own care [1, 2]. Systems that combine  high-quality  information  with  interactive components  for  self-assessment,  decision  support,  or behavior  change  have  the  potential  to  reduce  costs while maintaining the same or achieving better quality of care  [3].  A  system  that  incorporates  these  different features  is  eConsult|Plus  (developed  by  Medicinfo) which  combines  digital  triage  with  e-consultation.  For digital triage systems to be adopted and accepted, it is important  to  adjust  the  system  to  the  needs  and expectations of its users. A serious problem hereby is a discrepancy between the language of users and that of the system (inadequate language match) [4].The  system  under  investigation  matches  the description of  the complaint  entered by users  to  pre-defined complaints in a database. This matching occurs by  comparing  the  entered  description  to  a  list  of synonyms of the pre-defined complaints. The matched complaint  is  linked  to  questionnaires  which  provide triage  and  identify  the  urgency.  The  users  receive  a computer  generated  advice,  varying  from  “contact  a doctor  immediately”  to  sending  their  GP  a  question accompanied by the gathered information.  Objective: The aim of this study was to assess and improve the language match of a web-based system for digital triage in primary care in the Netherlands.Methods: A usability-test  (55  consults  by  19  unique  respondents)  was conducted to assess the language match of  the web-based  system  and  to  obtain  insight  in  the  users’ language.  These data were used to  complement  and adapt  the  database.  An  online  survey  (29  different respondents)  was  conducted  to  obtain  additional synonyms. Finally a second usability-test  (60 consults by 20 different respondents) was conducted to measure the effects of adapting the database.Results: The initial usability-test  revealed  that  the  system  returned  a response in 58,1% of cases (no response means the system  asks  the  user  to  rephrase  the  complaint)  of which only 64,5% included an adequate response. On average respondents needed 2,3 descriptions to get an adequate response. The average number of matching-problems  (problems  that  occur  during  the  description process and the system’s response) was 5,2. Overall, participants awarded the system with 6,23 (scale 1-10). The  second  usability-test  showed  significant improvement  in  all  areas:  82,4%  response,  of  which 91,0%  included  an  adequate  response;  users  only needed 1,42 descriptions to get an adequate response (p=0,001);  users  experienced 2,42 matching-problems (p=0,000);  the  overall  grade  increased  to  6,87 (p=0,004).Conclusions: Altering  and  expanding  the database of  the  system by making  use  of  the  actual language of users, significantly improved the language match,  resulting  in  more  adequate  responses,  fewer descriptions  needed,  less  problems  experienced  and respondents  valuing the system higher. This research shows  that  usability-testing  is  an  effective  way  of matching the language of systems and their users and that  improved  matching  not  only  leads  to  fewer problems, but also to higher ratings and eventually to improved adoption and acceptation of these systems.References1. Katz SJ, Moyer CA. The emerging role of online communication between patients and their providers. J Gen Intern Med 2004 Sep;19(9):978-83. 2.  Eysenbach  G,  Sa  E  R,  Diepgen  T  L. Cybermedicine.  Interview  by  Clare  Thompson.  BMJ 1999 Nov 13;319(7220):1294.3. Kerr C, Murray E, Stevenson F, Gore C, Nazareth I. Internet  interventions  for  long-term conditions:  Patient and caregiver quality criteria. J Med Internet Res 2006 Jul;8(3):e18.4.  Barry  CA,  Stevenson  FA,  Britten  N,  Barber  N, Bradley CP. Giving voice to the lifeworld. More humane, more  effective  medical  care?  A  qualitative  study  of doctor-patient  communication in  general  practice.  Soc Sci Med 2001 Aug;53(4):487-505.Poster 6Veronica Law, Graduate Department of Rehabilitation Science, University of TorontoInternet Use among Occupational Therapists in Their Clinical PracticeIntroduction There has been an increased use of the Internet in clinical practice for a broad range of health care  professionals;  however,  this  has  not  yet  been documented  for  persons  working  in  the  rehabilitation field.Objectives This  study  aimed  to  investigate  the  patterns  of  Internet  use  in  clinical  practice  among occupational  therapists.  Methods A self-administered,  structured  survey  was  mailed  to  all  provincially registered  occupational  therapists  (n=4050)  who engaged in  any form of  client  contact  (e.g.,  personal interaction or phone consultation). Descriptive statistics were used to describe their Internet use and bivariate data analyses were performed to identify relationships between  therapists’  characteristics  and  Internet  use. Barriers and facilitators to Internet use (e.g., paid time) were  also  examined.Results Of  the  1382  surveys  received that met the inclusion criteria for data analysis; majority of respondents were female, full-time therapists who  lived  and  worked  in  urban  areas.  A majority  of participants reported that access to information over the Internet was useful as their clinical information source. The top 3 facilitators for Internet use were: 1. "having a computer  at  work",  2.  "a  work  culture  that  fosters Internet  use"  and  3.  "the  availability  of  technical support". To a lesser extent, having paid time to access the Internet and the presence of regulatory guidelines (e.g.,  privacy  issues  related  to  emailing  clients)  were 44

Using usability-tests to improve language match of a web-based system for digital triage in primary care

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Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice. Soc Sci Med

Internet interventions for long-term conditions: Patient and caregiver quality criteria.

Interview by Clare Thompson. BMJ

The emerging role of online communication between patients and their providers.

https://ris.utwente.nl/ws/files/6162180/Kelders08using1.pdf

Using usability-tests to improve language match of a web-based system for digital triage in primary care

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