An NHS Direct Online Clinical Enquiry Service (CES), through which a nurse can discuss symptoms with patients over an web-based chat connection, could be expensive and take up too much time, a report from the Journal of Medical Internet Research shows. The pilot, which took place over six days in a GP’s practice in Coventry, concentrated on non-urgent cases who had already made appointments to see their GP. The prototype system used was leased from Instant Service USA, tailored to the needs of the study. Five NHS Direct nurses in Southampton responded to the patients. However, many sessions ended up being twice as long as they would have been over the phone, a fact that the report called “unacceptable from the financial point of view". Despite CES’s disadvantages, researchers called for further tests as the service was extremely popular with the public, several of whom felt that online CES would increase access to healthcare. But many also believed that it should be an addition to, rather than a replacement for, a regular phone-based service. One 80-year-old user commented that they appreciated being able to think and re-read their responses: “When you go to a doctor, you forget things because you’re a little bit nervous. Using this service you have more time to think and ask anything you want; you can see what you and the nurse said." Researchers did, however, concede that another combination of software might save more money, and that there was a correlation between the length of the chat and the age of the patient. The service would also have potential to help people who are deaf or socially isolated and those more comfortable typing than talking about their condition. However, there were issues with “signs of emotion and empathy… [being] hard to communicate” and “the possibility that patients might give untrue information that cannot be checked by the nurse." The report also recommended further tests with different software and in different conditions, especially with urgent cases. NHS Direct, which was launched in 1998, recently expanded its website to contain a basic FAQ about common health matters that patients could work through. Plans are afoot to launch an interactive TV service, featuring short video clips and diagrams, this summer.
