Overview

Isabel is a web based diagnosis checklist system. Signs and symptoms are entered, either by free text or taken directly from an electronic medical record and Isabel instantly returns a list of possible diagnoses. In addition, access to knowledge from textbooks, journals, external web resources and internal guidelines and protocols is provided for each diagnosis. The system provides essential support for enhancing diagnostic decisions within the normal workflow.

How does Isabel work?

The best way to see Isabel is to try it and you can sign up for a 10 day free trial. For some useful tips, view the User Guide.

Isabel can operate as a stand alone tool or as an integrated component of your EMR. As a stand alone tool, three simple steps provide immediate results. The patient’s age, gender, and positive clinical features are entered. The clinical features can include rich text such as ‘pain radiating to the back’ or ‘persistent cough’. It can also include test results such as ‘elevated ESR’. As an integrated component of your EMR, the data is extracted from the EMR and entered automatically.

The results, initially 10 diagnoses (more can be viewed with a single click), are displayed within seconds including flagged “Don’t Miss Diagnoses”. The results can be sorted by the most relevant, the most common, Don’t Miss Diagnoses and by specialty. In addition, you can view a list of likely medications that could be the cause of your patient’s symptoms by doing a causative drug search and also view a list of potential bioterrorist agents.

Additional information about each diagnosis is available with a single click. The knowledge and information includes textbooks, journal abstracts, links to institution defined web-resources, guidelines and protocols.

Isabel can be customized to include institutional knowledge resources, protocols and guidelines. For example, if the institution has developed a protocol for toxic shock syndrome the electronic format of the protocol can be made available to the clinician any time via the diagnosis checklist. This enables rapid access to critical data at the point of care when clinicians need it most without having to go to any other resource or reference material.

In addition to the clinical and safety benefits provided by Isabel, the system can be used to capture CME. Session information is captured and stored and can be used for recording category 1 CME credits within the normal workflow.

The Isabel engine?

The Isabel tool is the culmination of over 10 years and over 100,000 man-hours of continual development. The Isabel engine is powered by statistical natural language processing software. This engine is applied to a specially designed medical database built from continually updated medical textbooks and journals structured around 3 separate and proprietary taxonomies. The database currently contains over 100,000 documents and associated knowledge kernels. The software’s strength lies in advanced pattern-matching techniques (non-linear adaptive digital signal processing), that enable identification of the patterns that naturally occur in text, based on the usage and frequency of words or terms that correspond to specific concepts. The data entry and system outputs are further processed by a complex interplay of approximately 40 proprietary algorithms in order to ensure that the end results are highly accurate and relevant. The results are SNOMED coded enabling full integration with an EMR.

Isabel’s unique ability to analyze unstructured medical data and accept free text data entry makes it fast, easy and intuitive for clinicians to use.

Who would use Isabel?

Isabel should be used by any clinician facing diagnostic uncertainty. Isabel is designed to fit into workflow and support the clinical diagnostic decision making process for all types of clinicians (primary care, secondary care, specialists, nurse practitioners, etc.). Upon entry of the initial signs and symptoms a manageable list of 10 diagnoses is returned with Don’t Miss Diagnoses flagged. Once the list is generated there are a number of ways in which this list can be sorted. The list of diagnoses can be viewed by specialty, or rearranged by most common or most relevant diagnoses and additional diagnoses can also be displayed. From this list of diagnoses, knowledge on each of the diagnoses is made available with a single click. This flexibility allows Isabel to meet the diagnostic needs of various types of clinicians from nurse practitioners to specialists.

Isabel is also a powerful teaching tool as it teaches the clinician at the ‘teachable moment’.

When should Isabel be used?

Isabel should be used by the clinician who has diagnostic doubt about a patient’s presentation. Isabel is a tool that complements the clinician’s knowledge and expertise in determining a diagnosis, especially on unusual presentations. It is not meant to be used on every patient.

A useful question is to consider what you or your colleagues do today when there is diagnostic doubt. One major US health system actually surveyed their physicians and 44% of them said that they found 6-15% of their patients ‘difficult to diagnose’. If they have doubt but do nothing then they are running a considerable clinical risk. Currently most clinicians would ask their colleagues advice, go online or consult their textbooks. However, this is clearly disruptive, time consuming and commonly used reference resources are only useful if you know what you are looking for. Isabel is designed to be of immediate practical help to the clinician with diagnostic doubt by providing him or her with a list of diagnoses to consider thereby providing a structure of where to start looking right within their workflow, maximizing the speed and appropriateness of care for the patient.

How can Isabel be implemented and accessed?

Isabel is web based tool and can be accessed from virtually any Internet enabled device, including the iPhone, Android based smart phones, iPad and iTouch devices. Isabel can be used as a standalone tool or can be integrated into virtually any EMR for seamless use in your workflow. Because only small amounts of data are exchanged, response times are very fast even over wireless or cellular connections. This architecture allows Isabel to be used by any size organization from a single practice to a large health system.

What impact could Isabel have?

Isabel will help improve the speed to diagnosis and appropriateness of care resulting in higher quality care at lower cost.

• Test ordering: rather than leading to an increase in the ordering of tests, Isabel could enable a reduction in unnecessary tests as clinicians can be more specific in their ordering based on a targeted approach versus a broader, more generalized basis of ordering tests.
• Referrals: Isabel can significantly help improve the appropriateness of referrals. In trials, the use of Isabel has shown that in 15% of cases the clinician considered a referral to a specialist no longer necessary and in 50% of the cases where the clinician has referred a patient that Isabel has helped them refer more appropriately. This has a dramatic impact on speed of treatment, patient satisfaction and costs through a reduction of unnecessary tests and more efficient resource utilization.
• Admissions: as with referrals Isabel will help clinicians improve the appropriateness of admissions.
• Length of stay (LOS): Isabel will help reduce LOS by providing a means to deliver faster work up times for complex cases, speeding up treatment and an overall reduction of inappropriate admissions.
• Clinical risk: the use of Isabel clearly demonstrates and records the use of clinical judgement during the diagnostic work up of cases and will help reduce diagnosis risk, which is the leading cause of malpractice claims in both primary and secondary care.
• Clinical skills: Isabel will extend the clinical skills of all clinicians. Independent studies have shown a ‘significant’ increase in the diagnostic skills of medical students.

Has it been validated?

Isabel is almost certainly one of the most extensively validated decision support tools in use today. There are over 20 peer-reviewed articles covering its accuracy and utility.

How much does it cost?

There are various pricing models to suit both primary and secondary care, various practice settings and health system models. The system is sold on an annual subscription basis with no additional set up or implementation costs. The subscription includes usage of Isabel, integration with your EMR, training and future software updates to the system. Individual subscriptions are also available; click here for pricing.

What additional costs would I have?

There are no additional direct costs associated with Isabel. The only additional costs an institution might incur in using Isabel are entirely discretionary and are associated with the awareness and change management aspects of using the product. Isabel Healthcare offers considerable support and works closely with each customer’s designated internal champion to ensure success.

What are the next steps?

If you feel that Isabel would be of interest to your institution we would be happy to discuss this further with you and, if appropriate, present to your leadership. Please contact us at sales@isabelhealthcare.com.