Over 45 years ago, in 1968 Dr Lawrence Weed published an article on Medical Records that Guide and Teach which described the problem-orientated medical record (POMR) where organized problem lists and medical records are critical to clear decision making. The POMR was implemented worldwide and became a standard for medical documentation.
In 1971, Dr Weed spoke at the Grand Rounds at Emory University where he discusses the POMR approach:
- How Physicians cannot be expected to analyse the volumes of information that exist in a single patient’s paper medical record
- The practice of medicine is the way you handle data and determines what you think. What happens over time is the structure of the data determines the quality of the output.
- To analyse a patient record would take around 3 hours but even then its only as good as the information entered at the time and due to the variety of people involved in the care of a single patient the problem is huge. Information within the medical health record is separated into individual sections so it is impossible to see a timeline across all the data of what is happening at a particular point in time.
During the 1970’s Dr Weed lead an effort to develop an electronic version of the POMR. In Lee Jacobs, MD 2009 article Interview with Lawrence Weed Dr Weed describes how the development of the POMR then lead to the importance of integrating detailed patient data with comprehensive medical knowledge. Due to computer technology making available voluminous amounts of data which couldn’t be processed completely by the human mind he realized that medicine must transition to utilizing information technology to provide knowledge and processing capacity to the detailed patient data it receives. This information is then worked through by the Physician to rule in or rule out diseases, treatment and to evaluate the patient and their current health situation.
In 2011, Dr Weed and his son, Lincoln Weed published their book Medicine in Denial. In Terry Graedon’s recent editorial "Is Larry Weed right?" he states:
“According to the Weeds, misdiagnoses “are not failures of individual physicians. Rather they are failures of a non-system that imposes burdens too great for physicians to bear.” They argue that software tools should be employed first. Software linked to the medical evidence base could present a true list of probable diagnoses for physician and patient to consider together, rather than the ad hoc list of differential diagnoses that a doctor may construct based on his or her particular interests or specialization.
This scenario may sound like science fiction, but even science fiction aficionados have noticed that computers are gaining a diagnostic edge over many doctors. In research from Indiana University, the computer demonstrated greater accuracy in diagnosis than the human physicians. IBM’s Watson and the diagnostic checklist software Isabel are also being tested and refined to facilitate accurate differential diagnoses. Computers don’t suffer from sleep deprivation or distraction, and they shouldn’t display the kinds of unintentional biases (based on gender, ethnicity, or age) that beset human doctors.”
It may seem that over 45 years later Dr Larry Weed’s original vision “We need to better organize our records, better utilize paramedical personnel and appropriately use computers” is now available. Mark Graber, MD makes the comment at the end of Terry Graedon’s editorial that as systems such as Isabel are now available integrated into the clinical workflow that utilisation will increase but only with the realisation that Physicians need to be using tools such as these to enable them to cope with the increasing demands of their jobs and not to just rely on the limits of their own minds which have to process great volumes of information in ever decreasing time limits.
Yesterday the Daily Mail ran an article entitled “How to avoid misdiagnosis: The online ‘doctor’ even GPs swear by”
The online ‘doctor ‘referred to was actually the Isabel system used by GPs at the Vale of York Clinical Commissioning Group (CCG) and the Isabel symptom checker.
The article pointed out that payouts for misdiagnosis by the NHS Litigation Authority rose from £56mn in 2009-10 to £98mn in 2010-11. Bear in mind that payouts will represent just the tip of the iceberg for misdiagnosis.
The article reports how the Vale of York CCG is using the Isabel diagnosis checklist system for professionals and quoted Dr David Hayward:
"Experienced GPs become used to thinking in a certain way," says Dr David Hayward, a GP and board member of the Vale of York Clinical Commissioning Group.
"This system allows you to think outside the box. We don’t use it for every patient, but it is useful for complex cases.
"One colleague saw a patient whose blood showed signs of inflammation, and the symptom checker suggested pneumonia.
"The patient had no obvious symptoms of a chest complaint, but when he was sent for an X-ray he did have pneumonia."
The article mentions that the system costs about £1,400 per GP practice and, significantly, that doctors say that the costs are recouped “because more patients are referred to the right consultant the first time”. This is very important as it shows that Isabel is a practical tool to help improve the appropriateness of referrals.
The article also quotes Sir Graeme Catto, the former president of the General Medical Council on his view of the symptom checker:
“Doctors have always used textbooks — this symptom checker brings that concept up-to-date,” he says.
The comments to the Daily Mail article indicate a good deal of frustration with the health system and the increasing trend for patients to make sure they are better informed.
DDX tools could help to avoid diagnosis errors in the ICU
The idea for the Isabel diagnosis support tool first came to us while sitting in the ICU. A decade ago, my family and I were spending long hours in the ICU caring for our toddler, Isabel Maude, after she was diagnosed late with necrotising fasciitis. We realized the ICU doctors often can see the long perspective of what happened to a patient, as they see how the patient got there and what mistakes were made along the way. With the luxury of hindsight they can see, for example, that if only a clinician had, metaphorically, turned left instead of right then the patient would not have ended up in ICU.
So, with great interest I read a review of diagnostic errors actually made in the ICU in an article published by by Bradford Winters et al at Johns Hopkins.
http://qualitysafety.bmj.com/content/early/2012/07/20/bmjqs-2012-000803
Do we need more papers telling us how much diagnostic error exists? Hopefully the message is starting to get through. A salient point in this paper is that out of the 31 studies covering 5,863 autopsies, 28% reported at least one misdiagnosis. The authors estimate that as many as 40,500 adult patients annually may die in the ICU with a misdiagnosis. This number of predicted deaths is comparable to those from central line associated bloodstream infections or breast cancer.
The most interesting part, though, was what Winters said in the communications accompanying the paper:
“It may be counterintuitive to think that the patients who are the most closely monitored and frequently tested are more commonly misdiagnosed, but the ICU is a very complex environment,” Winters says. Clinicians face a deluge of information in a distracting environment in which the sickest patients compete for attention, most without being able to communicate with their medical team. “We need to develop better cognitive tools that can take into account the 7,000 or more pieces of information that critical care physicians are bombarded with each day to ensure we’re not ruling out potential diagnoses,” Winters says.
This point is yet another good argument for using differential diagnosis tools, like Isabel, that are designed to help clinicians make sense of information, rather than just giving them more of it.
~ Jason Maude, Founder of Isabel Healthcare. View the Video of Jason and his daughter Isabel telling their story.
One of the most tragic cases of diagnosis I have ever seen was widely reported in the UK last week. This article in the Daily Mail is the most detailed as the reporter had clearly read the judgement that was also published. In brief, the case deals with a young couple whose child died after presenting with seizures due to a fractured skull. The clinicians presumed the fractured skull to be as a result of child abuse and the parents were charged with murder. Both parents were wrongly imprisoned for some months but were finally cleared of murder after it was revealed that the child had rickets due to vitamin D deficiency and that the fracture was most likely due to the child banging its head while in its cot. The couple also had a second child that was born before they were cleared at trial, and she was immediately removed from them. Although acquitted of murder at the trial, the parents had to go through another court case to regain custody of their daughter. They finally won this case last week and are now back at home with their daughter!
The case is particularly tragic because the missed diagnosis of rickets may have been prevented, and it shows that this wrong initial step can lead to a cascade of awful events. The case is also a classic one of "premature closure" as the clinicians jumped to the conclusion of child abuse and then failed to consider any other reasonable possibilities. The judgement is extremely detailed and includes statements from several expert witnesses so enables us to see that there was virtually no discussion or consideration of any other possible diagnoses. The judgement also shows that the young couple appeared to be perfect parents with Jayden not showing any signs whatsoever of abuse.
Just by entering any one or a combination of Jayden’s symptoms: “seizures”, “fractured skull” or “low calcium” into Isabel (or the new iPhone app) may have reminded doctors to consider rickets as another important possible diagnosis. Instead, the diagnosis of “child abuse” was made to the exclusion of other likely and important diagnoses, triggering the cascade of horrific events to hit the family over the last three years. This case illustrates graphically why the use of tools like Isabel should become standard practice.
In the 21st century, when virtually every other industry is heavily reliant on information technology, our health should not be so dependent on a doctor’s memory and subjective views. In my view, hospitals and practices should be required to provide diagnosis checklist tools to support their clinicians in the same way that other tools are provided.
~by Jason Maude, Isabel Healthcare Founder
Isabel Healthcare and BMJ Group Introduce “Isabel with Best Practice”- the Next Generation Medical Knowledge System
Evidence-based diagnostic and treatment decision aid enables faster, safer and more accurate diagnoses and treatment at the point of care
___________________________
Full release:
Ann Arbor, Mich. and London, UK – January 24, 2012 – Isabel Healthcare and BMJ Group today introduced Isabel with Best Practice, a powerful diagnosis and treatment decision aid that combines the strengths of both companies’ existing systems to help clinicians diagnose and treat faster and more accurately at the point of care.
Under the international partnership, Isabel integrated its industry-leading diagnosis decision aid with BMJ Group’s Best Practice clinical content. Isabel with Best Practice will enable doctors and nurse practitioners to make more informed and faster diagnostic and treatment decisions. Isabel with Best Practice is the only diagnosis decision aid exclusively endorsed by BMJ Group and the only solution of its type that fully integrates with electronic health records.
“Isabel with Best Practice ushers in the next generation of decision support affording faster and
more accurate decisions,” stated Dr. Rubin Minhas, Clinical Director for BMJ Evidence Centre, a global provider of evidence-based decision support to healthcare professionals at the point of care. “For the first time, all the key information and decision tools are included in one system, saving the clinician valuable time at the point of care.” He added: “This exciting new product will enhance both companies’ product portfolios.”
A 2009 report published in the Archives of Internal Medicine titled "Diagnostic Error in Medicine: An Analysis of 583 Physician Reported Errors" suggests that doctors continue to commonly misdiagnose internal ailments to the detriment of patients.
“Diagnosis errors have a devastating impact on clinical and financial outcomes,” said Don Bauman, CEO, Isabel Healthcare. “Studies have shown that Isabel’s diagnostic decision support tool significantly drives better decision making in a compressed timeframe resulting in better outcomes, reducing waste and freeing clinicians to spend more time with patients.”
Isabel with Best Practice capitalizes on the unique ability of Isabel to produce a differential list using multiple clinical features with BMJ Group’s Best Practice’s easy to use evide
nce based disease monographs. When clinicians enter a patient’s signs and symptoms, Isabel with Best Practice generates a checklist of potential diagnoses while flagging high-risk “Don’t Miss” diagnoses. After a doctor selects a diagnosis, they are taken straight through to the BMJ Group’s Best Practice monographs where they are able to rapidly access information on other important symptoms and 1st and 2nd line tests to help with pinpointing the diagnosis and best practice and guidelines on treatment from the world famous BMJ Evidence Centre.
Physicians who have tested and are using Isabel with Best Practice overwhelmingly praise the tool.
“Access to the Isabel diagnosis checklist tool at the bedside is crucial as it helps speed up decision making at the point of care,” said Richard Chinnock, M.D., Chair of the Department of Pediatrics at Loma Linda University Children’s Hospital. “My physician team and I really like the addition of BMJ Group’s Best Practice evidence-based reference content. The schematic layout is especially helpful as you can access sequential steps for testing, treatment and guidelines from a single page.”
This next generation product is available today and will be on display at the upcoming 2012 HIMSS conference in Las Vegas, NV in the Isabel booth 13247, kiosk 7.
About Isabel Healthcare
Isabel Healthcare Inc. was founded in 2000 by Jason Maude and is named after Maude’s daughter who almost died after a potentially fatal illness was not recognized. For over 10 years, Isabel Healthcare has provided the Isabel diagnosis decision support system to hospitals, physician practices and individual physicians and gained peer reviewed validation and unmatched experience. Today, Isabel is the only diagnosis decision support system fully integrated with EMR and is used by thousands of physicians, nurse practitioners, physician assistants and students world-wide, providing diagnostic support and education by broadening their differential diagnostic considerations. Connect with us at info@isabelhealthcare.com, 734-332-0612 or Isabelhealthcare.com or info.isabelhealthcare.com/blog to learn more.
About BMJ Group
BMJ Group is a global provider of trusted and independent medical information and services for healthcare professionals. The BMJ Evidence Centre provides evidence-based decision support to healthcare professionals at the point of care. It is internationally renowned for its independent, thorough and robust analysis and synthesis of clinical research. BMJ Group is owned by The British Medical Association. http://group.bmj.com
###
Written by Dawn Bonsor, RN, VP Client Services, Isabel Healthcare
How often has a patient come into the doctor’s office who is convinced that they are suffering from a rare disease or illness? Perhaps your patient has spoken to friends who relayed stories about someone with similar symptoms who was ultimately diagnosed with a serious illness. Patients often arrive after reading pages of online medical information, have self-diagnosed their ailment and are quite concerned.
Imagine now that you are looking at a positive outcome for this panicked patient, and you are challenged with how to help them calm down. You have determined that the diagnosis is not life threatening or serious, and you need to change their perceived panic of “I may be very sick” to accept your diagnosis and treatment plan.
Each day I work with clinicians who use Isabel in their physician practices, multi-hospital systems or medical schools, and I see how physicians have thought of new ways to leverage the power of Isabel and apply it to their medical practices to improve care and diagnosis accuracy.
Recently, I visited several physicians at South Arkansas Medical Associates (SAMA) who use Isabel with their patients to help explain the thought-process of finding possible diagnoses and rule out obvious and not-so-obvious diagnoses. Doctors describe to the patient what Isabel does, enter the data, and then discuss the diagnostic suggestions that Isabel presents.
Using the Isabel medical diagnosis tool with patients has helped physicians reassure the patient of their thought process and thoroughness. They have been able to allay patient fears regarding the possibility of the serious illness they suspected and reassure the patient with the level of consideration that is being placed into determining an accurate diagnosis.
As we start the new year, we resolve to achieve improvements in all we do, including our medical practices and patient diagnosis efforts.
Diagnosis is the first and most important decision made about the patient -- it determines all subsequent treatment and determines the course of each patient encounter. How well this decision is made, therefore, is one of the most significant determinants of healthcare quality and efficiency.
The following are six areas where the speed and accuracy of diagnosis has a key impact and where the use of a medical diagnosis decision tools help achieve improvements.
- Referrals – Primary care to Specialists: Research shows that 30-50% of referrals from primary care to specialists are inappropriate leading to delays in diagnosis, patient dissatisfaction and lengthy waits at specialist clinics.
- Test ordering: Surveys and anecdotal evidence put the level of unnecessary and defensive test ordering at 40%. This is extremely costly and subjects patients to unnecessary clinical risk through invasive procedures and radiation exposure.
- Mitigating Risk – Medical Malpractice: Misdiagnosis accounts for 30-40% of all malpractice claims and about 2/3 of all claims in primary care.
- Patient Satisfaction: Since patient satisfaction will soon account for 30% of Medicare payments many hospitals are investing in typical customer service initiatives used for years in other industries. However, in many cases these are viewed as gimmicks and will not make up for poor quality of care. A survey of patients’ concerns showed that their top concern when visiting their primary care physician is diagnosis and in hospitals it’s their 2nd most important concern.
- Employee skills – Extending mid-level clinicians: Healthcare is a knowledge intensive industry and a key issue underpinning an institution’s success is the clinical skills of all its clinicians. One way of boosting skills cross the board is to provide tools that increase clinical skills.
- Improving the Thought Process: The most common causes of diagnosis error are related to how a doctor thinks. There is now a large body of work describing the many biases that we, as human beings not just clinicians, are prone to. Premature closure, where the clinician decides on a diagnosis very quickly but then fails to consider other reasonable possibilities until it’s too late is the leading cause. Clinical analytics and decision support embedded as part of the clinical workflow can assist in getting the clinician to consider other possibilities.
Diagnostic Error is the leading cause of medical error. It happens frequently, is almost always preventable and causes the most harm. There is now a large body of research demonstrating the size of the problem and why it happens.
Better Than Asking a Colleague: In most cases today, if a clinician does have diagnostic doubt and wishes to investigate further they typically will have to consult with colleagues, read textbooks or go online. With medical textbooks and online reference resources it is very difficult to search for something when you don’t know what you are looking for.
This area is where diagnosis decision support aids can help as they are designed to produce a list of likely diagnoses for a given set of signs and symptoms. Their job is to get the clinician thinking about a disease that he had not thought about. Instead of taking several hours, days or even years in some cases to suggest the right diagnosis using the traditional methods, the diagnosis decision aids work in seconds. These tools buy the time that the clinician needs to think.
To learn more about Isabel medical diagnosis tools, visit www.Isabelhealthcare.com
Whether the debate is at the national healthcare reform level or down at the level of a specific episode of care for a certain patient, a large part of the discussion about how to deal with the many ills of the US healthcare situation has focused on cutting back on benefits or care covered and/or requiring patients to pay more for their care. In this discussion we have paid much less attention to a third broad, equally or even more important approach – improving the way we deliver care or improving the productivity of our clinical delivery systems.
Called process improvement/re-engineering in other industries, it is high time that the healthcare industry began to think strategically about improving the clinical productivity of its processes and care delivery approaches, and re-allocate resources in a way that supports this new strategic thrust. Various estimates indicate that we could wring out about a third of the total $2.5 trillion the US spends annually on healthcare through quality improvements that increase clinical productivity.
Further, we believe that if you look across the clinical process at various possibilities for improving clinical productivity, the biggest clinical and financial benefits will come if we first make improvements to the upstream clinical inputs that drive the decisions that produce downstream clinical outputs/outcomes – as other industries have done. And the three most seminal, initiating of these upstream clinical inputs are the quality of patient data, the quality of the cognitive processing clinicians carryout on/with that patient data, and the resulting quality of the diagnosis decision for a given patient – that is the speed, completeness and accuracy of the diagnosis decision.
In turn, if the diagnosis decision is wrong, every clinical decision downstream of that diagnosis decision will be wrong, wasteful and harmful – e.g. referral decisions, decisions about labs, tests, images, treatments, which will cause unnecessary complications, adverse events, morbidity, mortality, readmissions, and related increases in healthcare, legal and worker productivity costs (i.e. lost days of work).
To date, most of the healthcare industry’s attempts to improve quality have gone to downstream activities such as figuring out what outcomes to measure, going out and measuring those outcomes, EBM, bringing in CPOE system to cut down on treatment errors, etc. While these have been worthwhile investments, a number of recent studies on quality strongly suggest that over the last ten years quality has not improved that much and may have even declined.
Given the key initiating upstream position of diagnosis decision making, doesn’t it make sense for the healthcare industry to consider reallocating more of its quality/clinical productivity improvement efforts into systems that help clinicians improve their diagnosis decision making? If these diagnosis decision support systems (DDSS) could reduce diagnosis errors by 10%, their total clinical and financial benefit and ROI across a given episode of care would be a multiple of this 10% because most of the downstream clinical mistakes and costs associated with the upstream diagnosis error which would be avoided.
Because of this large positive multiplier effect across and down the entire clinical cascade of a given episode of care, we believe that investments in DDSS may generate a far higher clinical and financial ROI than most other attempts to improve quality and clinical productivity. Furthermore, by preventing these downstream clinical “speed bumps,” “do-overs,” delays, harm and costs, DDSS can streamline clinical workflows and processes, enabling clinicians and their clinical systems to operate more productively – e.g. serve more patients at a higher quality and lower cost per episode of care, which in turn will grow the top revenue line and gross margin line of the healthcare organizations for which these clinicians work.
~~ George Reigeluth, VP Isabel Healthcare
Rosalind Franklin University of Medicine and Science (RFUMS) in North Chicago, Illinois has used the Isabel Healthcare diagnosis decision support tool as part of its medical curriculum since 2007. The Chicago Medical School at RFUMS offers a doctor of medicine graduating 190 students each year and is a national leader in inter-professional medical and healthcare education.
WHY USE ISABEL WITH STUDENTS?
RFUMS faculty noticed that students frequently tend to use familiar, though potentially less credible clinical resources such as Google or Wikipedia to inform their learning and clinical decisions. As a result of these observations, the administration decided to look for a tool that could be used to provide trustworthy, and accurate medical information as well as lend support to their curriculum in safety, prevention and professionalism. RFUMS has found Isabel to be a helpful addition to their curriculum and training.
AVOIDING PREMATURE CLOSURE
Developing student clinical reasoning skill is an essential component of medical training. Since electronic informatics tools are regularly used to help physician’s refine their diagnostic accuracy in clinical settings, RFUMS sought to find a tool to help their students learn the diagnostic reasoning process, refine their diagnostic accuracy, and learn about the causes of diagnostic error, including premature closure. Due to their relative inexperience, students are more prone to premature closure, a phenomenon where a physician considers a patient’s symptoms to be evidence of one specific diagnosis and then stops considering other reasonable possibilities. While more common in student populations, diagnostic errors occur in practicing professionals and are often the result of a physician not considering other likely options.
ISABEL: MANDATORY IN MED SCHOOL TRAINING
RFUMS now includes use of Isabel in various parts of their curriculum, specifically as students learn how to interview a patient develop and initial differential diagnosis. At RFUMS, Isabel is a mandatory component of training for the University’s Chicago Medical School students. In addition, all RFUMS students and faculty, including the College of Health Professions and the Dr. William M. Scholl College of Podiatric Medicine, have access to it for the purpose of educational instruction and learning.
According to John Tomkowiak, M.D., M.O.L, Associate Dean for Curriculum and Jim Carlson, MS, PA-C, Director of Interprofessional Simulation at RFUMS, one of the hardest skills to teach medical students is the ability to reason and recognize ones own limitations – it is this skill that differentiates the average clinician from the excellent one.
“Educators have consistently looked for approaches to not only teach this essential skill, but to assess it. With the new Isabel system, we can do both,” he said. Dr. Tomkowiak noted that computer technology is rapidly gaining momentum in hospitals and medical practices around the country. Having students learn and understand its benefits and limitations will allow them to be better prepared to practice when they are on their own, he said.
To evaluate their students, RFUMS measures the impact of using Isabel on the quality of their differential checklist before and after use of the system. Second year medical students use Isabel during the patient interview process in order to help guide them in initial data gathering (history and physical) while the fourth year students use Isabel to improve the quality and accuracy of their differentials after taking a history.
ISABEL GETS YOU THINKING
The medical school created and launched its own internal study of the usage of Isabel. RFUMS found in their observations and study that Isabel helps students collect important historical and physical information as well as develop a more accurate list of differential diagnoses. As one student commented, “Isabel gets you thinking about what you are supposed to be thinking about.”
The RFUMS administration believes that Isabel is a valuable education tool for their environment specifically because it provides active versus a passive participation in the learning process. “Isabel helps our students actively pull out the clinical information to make better decisions,” stated Mr. Carlson.
MacNeal Hospital has been using the Isabel diagnosis checklist tool since 2008 with their 600 clinician users. As a 427-bed fully accredited teaching hospital, MacNeal Hospital serves the healthcare needs of more than one million people in suburbs of Chicago, Illinois.
WHY MACNEAL HOSPITAL CHOSE ISABEL HEALTHCARE
The MacNeal Hospital clinicians and Dr. Charles Bareis first discovered the Isabel Healthcare diagnosis checklist tool when their clinical book club read the book “How Doctors Think” by Jerome Groopman, MD. Reading and discussing the book caused the group of doctors to think about what they could do differently with patients to improve care.
Misdiagnosis is not a typical topic discussed among physicians, and as Dr. Bareis noted, “Doctors do not make a practice of talking about the diagnosis they missed.” However, in this group, they began to talk about it, and they came to a common understanding that they needed a level of humility to improve care quality and possibly make some breakthrough improvements for their patients.
INITIAL MACNEAL HOSPITAL CHALLENGES
MacNeal Hospital sought a solution for diagnosis that would be electronically-based, innovative and with a high reliability. With the goal of moving away from print-based research, the MacNeal team wanted their teaching hospital to have the best and most innovative resources to teach their new doctors and they wanted those tools to permeate the hospital.
When they had begun using Isabel, Dr. Bareis was responsible for MacNeal Hospital’s Library Services department. The team aimed to migrate to electronic research materials, and Isabel was the computer-based diagnosis tool they chose for their physicians. Before installing the Isabel tool, the staff relied partially on the Internet/Google or electronic clinical resources for their diagnosis and medical research.
The doctors had frank discussion among themselves regarding cases they were involved in which had missed or delayed diagnosis, and they felt it was advantageous to use Isabel for diagnosis throughout the hospital. No other tools were considered to have the capabilities of Isabel, so they decided to implement Isabel for all 600 physicians.
Dr. Bareis noted that their physicians and staff need Isabel, “primarily because no one can keep all the information in their heads.” Relying on Isabel for the most current diagnoses and clinical information has strengthened their clinical care, giving reassurance to physician, patients and their families.
MACNEAL HOSPITAL PATIENT CASE EXAMPLE
An older retired attorney presented with weight loss and hypotension, he was hypothermic, had a normal thyroid, and was not hyperadrenal; the patient seemed to have a case of the “dwindles,” meaning that he was not sick enough for hospice, but he was not getting better. The MacNeal physician consulted Isabel for diagnosis assistance. Neuromuscular disease appeared on the Isabel checklist as a possible diagnosis.
The patient had been previously diagnosed with hereditary proximal myopathy. When the physician researched hereditary proximal myopathy, he discovered that a patient could become hypothermic. This symptom is rare, and in fact, a neurology consult missed this point; however the physician was able to determine the cause.
The final outcome was that nothing could be done to help this patient in the end stages of his life; however, the physician reported that reaching the correct diagnosis gave the patient’s family great relief to understand the condition so they could treat the symptoms and not worry about other causes.
BENEFITS OF ISABEL AT MACNEAL HOSPITAL
Training New Staff: Isabel helps MacNeal Hospital train its new staff, as they use the Isabel diagnosis checklist to guide new residents and mentor new physicians on their rounds.
Reassurance: Many of the 600 physicians actively use Isabel during their patient consults, and they note that Isabel is an instrumental tool that helps reassure the physician as well as the patient and patient’s family of the diagnosis they reached.
Validation Against Malpractice: Located in Cook County, MacNeal Hospital is a misdiagnosis litigation “hot spot,” and has some of the highest malpractice litigation rates in the United States. The MacNeal Hospital team finds using Isabel helpful from a validation perspective for their patient cases, and physicians often print the results from Isabel to place in patient records.