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| Isabel Healthcare
London |
Isabel Decision Support System incorporating Diagnosis Reminder System and Knowledge Mobilising System |
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| keywords |
clinical domains |
Clinical Decision Support System, Diagnosis Reminder System, Knowledge Mobilising System,
differential diagnosis,
clinical algorithms, workflow, medical
error, quality, internet, WWW, PDA.
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Multiple.
Internal Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Geriatrics, Oncology, Toxicology, Bioterrorism |
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| coverage |
 USA
 UK
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| demonstrations |
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| downloads |
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| free trials |
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| documents |
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| product information |
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Isabel Diagnosis Reminder System (IDRS)
- Isabel was created in 2001 by physicians to offer diagnosis decision support at the point of care.
- Isabel has been extensively validated and been shown to enhance clinician’s cognitive skills and thereby improve patient safety and the quality of patient care
- Isabel covers all ages (neonates to geriatrics) and all major specialties and sub-specialties in Internal Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Geriatrics, Oncology, Toxicology and Bioterrorism.
- Isabel is fast and easy to use & gives the clinician an instant list of likely diagnoses for a given set of clinical features (symptoms, signs, results of tests and investigations etc).
- Following on from history taking and clinical examination Isabel assists the provider [“learned intermediary”] by reconciling [pattern matching] patient data sets with data sets as described in established medical literature (textbooks and journals).
- Isabel also has the ability to suggest causative drugs for clinical features entered and allows clinicians to follow their hunches by related diagnoses and restricting searches to specific body systems.
- Isabel has been interfaced with electronic medical record systems [EMR] (including systems from NextGen and Allscripts). Isabel is able to extract pre-assigned data from an EMR - on a single click delivers diagnoses and knowledge to the EMR user [no data entry into Isabel required]. Isabel has been integrated via a web-based interface with the NextGen, All Scripts-A4, Patient Keeper EMR.
Isabel Knowledge Mobilising System (IKMS)
- Isabel not only assists in making the right diagnosis but IKMS helps answer clinical questions with up to date knowledge from textbooks and journals
- Isabel uses natural language processing software as opposed to standard key word searches.
- Isabel starts at an earlier point in the clinical journey, and helps the clinician reach a diagnosis first, and then helps to mobilize medical knowledge related to the disease.
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| references |
Ramnarayan P, Roberts GC, Coren M et al.
Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a quasi-experimental study.
BMC Med Inform Decis Mak. 2006 Apr 28;6(1):22
[PubMed]
[]
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"
ABSTRACT: BACKGROUND: Computerized decision support systems (DSS) have mainly focused on improving clinicians' diagnostic accuracy
in unusual and challenging cases. However, since diagnostic omission errors may predominantly result from incomplete workup in
routine clinical practice, the provision of appropriate patient- and context-specific reminders may result in greater impact on
patient safety. In this experimental study, a mix of easy and difficult simulated cases were used to assess the impact of a novel
diagnostic reminder system (ISABEL) on the quality of clinical decisions made by various grades of clinicians during acute
assessment. METHODS: Subjects of different grades (consultants, registrars, senior house officers and medical students),
assessed a balanced set of 24 simulated cases on a trial website. Subjects recorded their clinical decisions for the cases
(differential diagnosis, test-ordering and treatment), before and after system consultation. A panel of two pediatric consultants
independently provided gold standard responses for each case, against which subjects quality of decisions was measured.
The primary outcome measure was change in the count of diagnostic errors of omission (DEO). A more sensitive assessment of the
systems impact was achieved using specific quality scores; additional consultation time resulting from DSS use was also
calculated. RESULTS: 76 subjects (18 consultants, 24 registrars, 19 senior house officers and 15 students) completed a total of
751 case episodes. The mean count of DEO fell from 5.5 to 5.0 across all subjects ...; no significant interaction was seen
with subject grade. Mean diagnostic quality score increased after system consultation... ISABEL reminded subjects to
consider at least one clinically important diagnosis in 1 in 8 case episodes, and prompted them to order an important test
in 1 in 10 case episodes. Median extra time taken for DSS consultation was 1 min (IQR: 30 sec to 2 min). CONCLUSION: The provision of patient- and context-specific reminders has the potential to reduce diagnostic
omissions across all subject grades for a range of cases. This study suggests a promising role for the use of future
reminder-based DSS in the reduction of diagnostic error.
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Ramnarayan P, Tomlinson A, Kulkarni G, Rao A, Britto J.
A Novel Diagnostic Aid (ISABEL): Development and Preliminary Evaluation of Clinical Performance.
Medinfo. 2004;2004:1091-5.
[PubMed]
[]
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Clinical diagnostic aids are relatively scarce, and are seldom used in routine clinical practice, even though the burden of diagnostic error may have serious adverse consequences. This may be due to difficulties in creating, maintaining and even using such expert systems. The current article describes a novel approach to the problem, where established medical content is used as the knowledge base for a pediatric diagnostic reminder tool called ISABEL. The inference engine utilizes advanced textual pattern-recognition algorithms to extract key concepts from textual description of diagnoses, and generates a list of diagnostic suggestions in response to clinical features entered in free text. Development was an iterative process, relying on sequential evaluation of clinical performance to provide the basis for improvement. The usage of the system over the past 2 years, as well as results of preliminary clinical performance evaluation are presented. These results are encouraging. The ISABEL model may be extended to cover other domains, including adult medicine.
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Ramnarayan P, Tomlinson A, Rao A, Coren M, Winrow A, Britto J.
ISABEL: a web-based differential diagnostic aid for paediatrics: results from an initial performance evaluation.
Arch Dis Child. 2003 May;88(5):408-13.
[PubMed]
[ADC Online]
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"AIMS: To test the clinical accuracy of a web based differential diagnostic tool (ISABEL) for a set of case histories collected during a two stage evaluation. METHODS: Setting: acute paediatric units in two teaching and two district general hospitals in the southeast of England. ... Conclusion: ISABEL showed acceptable clinical accuracy in producing the final diagnosis for a variety of real as well as hypothetical case scenarios."
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Ramnarayan P, Britto J.
Paediatric clinical decision support systems.
Arch Dis Child 2002 Nov;87(5):361-2.
[PubMed]
[ADC Online]
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"
A computerised clinical decision support system (CDSS) is "a computer based tool using explicit knowledge to generate patient specific advice or interpretation".1 Our use of computers has been driven not only by the increasing need to manage large amounts of information, but also by the imperative to make evidence based and cost effective decisions on a daily basis.2 Furthermore, there is accumulating evidence to prove that computer aided medical tools address the growing information needs of the busy clinician3 and improve healthcare processes as well as patient outcomes.4 In turn, this has led to the rapid proliferation of a variety of CDSS. This leading article summarises the past, present, and future of such systems, with special emphasis on their role in paediatrics.
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| founded |
2004.
The first (pediatric) version of the Isabel diagnosis reminder system was launched in June 2002, funded by The Isabel Medical Charity (a UK registered charity).
Isabel Healthcare is a wholly owned subsidiary of the Isabel Medical Charity (UK).
The Isabel product range is now delivered by the charity’s fully owned commercial subsidiaries, Isabel Healthcare Inc. and Isabel Healthcare Ltd.
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| contact |
Isabel Healthcare Inc.
PO Box 8393
Reston
Virginia 20195-8393
USA
T: +1-703-403-8377
In the UK:
Isabel Healthcare Ltd.
PO Box 244
Haslemere
GU27 1WU
UK
T: +44(0)1428-644-886
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| links |
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| acknowledgements |
| Dr. Joseph Britto MD, CEO and Co-Founder, ISABEL Healthcare |
| page history |
Entry on OpenClinical: 27 October 2003
Design template v0.3: 16 April 2005.
Last main updates: 27 October 2003, 26 January 2005, 03 June 2006 |
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Demonstration of Isabel EMR Integrator Module with Diagnosis Reminder System [requires pre-registration]