How Isabel - Diagnosis Decision Support is used in residency programs

Isabel is used around the world by physicians, physician assistants and nurse practitioners.  In the United States, within the hospitals, physician practices, medical and nursing schools that use Isabel, we see the various groups incorporating Isabel into their workflow.  Now that Isabel is available on smart phones and tablets such as iPhones, Droids and iPads, Isabel is that much more accessible at point of care.  Today we want to talk you about how several residency programs around the country have integrated Isabel into their workflow.  

• Residents have adopted the use of Isabel and prepare for rounds by running their more complex cases through the tool.  They use Isabel to prepare themselves for the discussion when they are challenged by their teacher or attending to explain why disease “x” should not be considered and disease “y” should be.  Isabel is commonly cited in discussions. Attending’s have told us that they are questioned  by their residents on a regular basis regarding the inclusion of a diagnosis based on an Isabel search.
• Residents are instructed to use a custom template in order to gather and record data on history and physical.  They are then carried through a process of assessment and analysis and must provide a list of potential diagnoses.  The process involves a mechanical review of considering all possible diagnosis associated to a list of all body systems.   The resident is then instructed to  input what  they feel is pertinent through  Isabel in order to review, validate, broaden and provoke further analysis of the differential list they created for each body system.   
• The medical student within the medical team rounding on their patients is tasked with running an Isabel differential on every patient prior to rounds.  This helps the medical student understand what some of the potential issues are, as well as  be ready for the team if the Isabel checklist is needed for discussion.
• Residents are instructed to consider using Isabel on patients who have been in hospital for 2 days or longer and have no definitive diagnosis.  They use 2 days as a trigger to incorporate the use Isabel into their workflow.
• Students have been instructed to integrate Isabel into their simulation labs.   Their process involves interviewing and examining the patient, exiting the room after 10 minutes, gather their thoughts and run the case though Isabel.  This is followed by a return to the exam room to complete their examination and questions.  The medical school teachers discovered that using Isabel has helped the students better focus their questions and create more appropriate differentials.
• During rounds the staff physician will ask if a patient has been “Isabeled” when there is some question from the group as to what is going on with their patient. They will also use the Isabel Knowledge page, where they have access to guidelines and treatments via multiple resources, text books and journals, at POC when discharging a complex case.  This is done to ensure they identify all discharge orders and all patient instructions have been covered.  They feel this avoids having patients return for missed orders or instruction. 
• During resident orientation the chief resident presents the key areas where technology in the form of resources can assist the students.   This is done due the large number of resources available to them.  This helps the residents zero in on the most effective tools for the various tasks.   Four key areas are reviewed (1) Drug reference (2) Library/ Database searches (3) POC evidence based summaries and (4) Diagnostic support tools.  The Isabel Knowledge page is identified as a POC evidence based summary and Isabel’s checklist is highlighted as a tool to help them with  Diagnostic support.