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New online diagnostic tool launched to help doctors

BMJ 2002; 324 doi: (Published 22 June 2002) Cite this as: BMJ 2002;324:1478
  1. Claire McKenna
  1. BMJ

    A paediatric online diagnostic tool called Isabel was launched at the Royal College of Physicians in London this week.

    The tool has been developed by a charity, also known as Isabel, which was launched by Charlotte and Jason Maude, whose daughter Isabel almost died at age 3 years of necrotising fasciitis as a complication of chicken pox, after it was missed by a series of doctors. The diagnostic tool was set up with help from paediatric intensive care consultant Joseph Britto at St Mary's Hospital in London, who helped to save Isabel's life.

    Isabel has since made a full recovery but will need reconstructive plastic surgery later in life to the skin on her abdomen. Jason Maude, who left his job to work on the charity, said he believed that “the system was at fault and not the junior doctor” for Isabel's missed diagnosis. The Maudes and Dr Britto decided there was a need for a near-patient diagnostic tool containing a wealth of paediatric knowledge that would help doctors in the differential diagnosis of paediatric illnesses.

    The Maudes, who have put £35 000 ($52 000; €55 000) of their own money into the charity, worked with Autonomy Corporation Software and Harcourt Medical Publishers to design the tool. The software used is able to search established paediatric textbooks by context and meaning rather than just by word and is designed to be very fast.

    The system is designed for health professionals only, as symptoms must be entered in medical terminology. It is free for health professionals, who must register with the Isabel charity to access the software online. There are currently 3000 registered users. The system provides a differential diagnosis from the symptoms entered by the user and visual corroboration is available in the form of pictures and scans. A treatment regimen is outlined for each suggested illness and the software automatically links any drug mentioned to the BNF (British National Formulary).

    Lord Hunt, health minister for IT and clinical quality, who attended the launch, emphasised that the software was a support system but it was the doctor who must use his or her clinical training to decide on a diagnosis.

    The Isabel tool also contains a section where health professionals can provide information (anonymously if they so wish) about clinical situations where they missed a diagnosis or learned something new. Dr Britto believed this section was important because health professionals “do not have enough of a culture of learning from and disseminating mistakes.”

    Trials in four hospitals have found that in 95 out of 100 paediatric cases, the Isabel tool came up with the correct diagnosis. More extensive trials are planned for August of this year.

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