I met Jason and 
            Charlotte Maude in the summer of 1999, in the most unthinkable of 
            circumstances. Their three-year-old daughter, Isabel, lay close to 
            death in St Mary’s Hospital in Paddington, London, ravaged by a 
            flesh-eating bug that doctors in another hospital had failed to 
            spot. The symptoms had been attributed to chickenpox, from which 
            Isabel was also suffering. Charlotte described the horror of seeing 
            her daughter go into toxic shock and being given oxygen to keep her 
            alive; Jason told me, almost inaudibly, of his numbness as Isabel 
            was taken to St Mary’s under police escort. 
            The couple told their story not, unusually, because they wanted 
            to sue somebody for the ordeal that had befallen them (the Maudes 
            had asked for medical help several times during the previous three 
            days). They wanted to set up a safety net to spare children the pain 
            and danger faced by their daughter, now a happy, healthy 
            five-year-old. They envisaged a nationwide computer system that 
            would allow any doctor to tap a list of symptoms into a database and 
            get back a list of possible diagnoses. “There is so much medical 
            information available on the Internet and it seems crazy that 
            nothing has been developed for hospitals,” Jason told me at the 
            time. 
            
I wondered whether their good intentions might evaporate as 
            Isabel settled back into normal life. Instead, they have taken the 
            first step towards realising their vision. Together with doctors, a 
            software company and generous donations from the City, the Maudes 
            have developed a software programme that will be the safety net that 
            Isabel never had. The software, called Isabel and in the advanced 
            stages of testing, is available free over the Internet to any bona 
            fide health worker (there is no public access). It will be launched 
            at a meeting of the Royal College of Paediatrics and Child Health 
            tomorrow by Dr Joseph Britto, a consultant in paediatric intensive 
            care at St Mary’s, who has been closely involved. Jason cannot 
            believe they are so close to achieving their aim: “It still seems 
            quite fantastical to me.” 
            
The way the NHS is organised, Britto says, makes misdiagnoses 
            very possible. “It’s the inverted pyramid in the NHS,” he says. 
            “Potentially critically ill patients such as Isabel are seen by the 
            most junior doctors in A&E. In her case, they spotted the 
            chickenpox, then moved on. Despite the high fever and bluish 
            discoloration — the clear features of the flesh-eating bug 
            necrotising fasciitis — she was sent home. Two days later she had 
            multiple-system failure and needed aggressive resuscitation. It is 
            amazing she has come through this neurologically intact. 
            
“During those long nights I spent in the corridor with Jason, he 
            kept saying that surely there’s a way of arming junior doctors with 
            more knowledge. It looked to me like something we could work on.” He 
            shared many sleepless nights with the Maudes as Isabel recovered, 
            and offered to work closely with them on the project. The three have 
            become firm friends — the Maudes named their third child Joseph 
            after Britto, who is his godfather. Isabel also has a younger 
            brother, Sam. 
            
Tap a list of symptoms into Isabel and it will respond with a 
            list of plausible and relevant diagnoses of childhood conditions. 
            Where those on the frontline — often junior doctors pressed for time 
            — generally look for the usual, Isabel also catches the unusual. Not 
            only that, but it will give detailed descriptions and photographs. 
            This saves fumbling in medical files for guidelines on, for example, 
            what to do if a child has an epileptic fit, and gives guidance if a 
            doctor has never seen a particular condition before. The software 
            also provides an instant link to the British National Formulary, the 
            standard reference on medicines. In addition, medics can post 
            details of their own mistakes or experience, anonymously if they 
            prefer. 
            
The software is not completely refined — the accuracy of 
            diagnosis is running at between 80-90 per cent — but tomorrow’s 
            presentation to the paediatric community should encourage other 
            doctors to try it. The software is on trial at four teaching 
            hospitals, including St Mary’s and Addenbrookes in Cambridge. These 
            trials are ensuring that the programme is returning sensible 
            diagnoses. 
            
Poignantly, typing in Isabel’s symptoms turns up the suspect 
            bacterium thought to be responsible for necrotising fasciitis, which 
            ate away at her abdomen and pelvis. Isabel was saved by surgeons 
            cutting away the dead flesh; she will need six further operations 
            over the next two years to rebuild her abdomen and groin as she 
            matures. 
            
She has blossomed into a charming, carefree child, seemingly 
            unaware of the trauma she faced or the project she inspired. When I 
            visited the Maudes at their London home, Isabel trotted downstairs 
            clutching Pee-Pee, a little cloth Peter Rabbit. The last time I saw 
            Pee-Pee, it was hanging from a ventilator in the intensive-care unit 
            at St Mary’s. Isabel bears well-hidden scars on her leg where skin 
            has been removed to graft on to her tummy, but they are nowhere near 
            as prominent as the normal grazes and bruises that are the battle 
            wounds of most toddlers. 
            
“Isabel loves dressing up, especially as a nurse,” says 
            Charlotte, a former public relations executive. “She now wants to be 
            a nurse when she grows up. We keep gently suggesting ‘doctor’ but 
            she has firmly told us that doctors are men and nurses are women.” 
            
Sometimes, Charlotte says, she feels as if Isabel’s brush with 
            death happened in a remote, parallel life. “Every so often I look 
            back and think ‘Did we really go through all that?’ We each recall 
            specific incidents, like waking up at 4am and being told pretty much 
            that we’d lost her. The doctors said they hadn’t felt a pulse for 45 
            minutes. We were told about possible brain damage. We had to wait 
            two weeks before we knew.” 
            
Jason adds: “If I’m talking about it with someone, tears come to 
            my eyes. It’s a reflex inside you — you become very emotional.” The 
            couple find it almost impossible to put into words their gratitude 
            that Isabel survived. In some ways the experience encouraged them to 
            have Joseph. “When you go though something like this you realise how 
            fragile life is,” says Jason. 
            
As head of global equity research at AXA, Jason used his City 
            connections to secure £90,000 in donations to set up the Isabel 
            Medical Charity. Autonomy Corporation has allowed the charity to use 
            its software for nothing (it would normally cost about £300,000, and 
            its head, Mike Lynch, is an Isabel trustee). Harcourt Health 
            Services, the medical publisher, gave permission for its paediatric 
            textbooks to be incorporated into the program. The Maudes put in 
            £34,000 that they received when the RAC club was demutualised. There 
            is a 30-strong editorial board of mainly paediatricians overseeing 
            the content of Isabel. The board features representatives from the 
            General Medical Council. All doctors and trustees are giving their 
            services free; the site has none of the advertising that litters 
            other medical databases. 
            
The medical community’s response to Isabel has been “incredible, 
            unbelievable”, Britto says. He thinks such software should be used 
            widely throughout the health service and notes that 11 per cent of 
            patients suffer an “adverse event” while in hospital, such as an 
            incorrect dose of medicine or a misdiagnosis. It is no coincidence, 
            he says, that litigation is growing. Having an intelligent computer 
            program to refine or reinforce diagnoses might well become more 
            important to the NHS to avoid charges of negligence. Putting 
            computers in hospitals, where they could save lives, would also be 
            an ideal and practical way of realising the Government’s commitment 
            to online Britain. 
            
Britto points out: “These errors cost the NHS a billion pounds a 
            year. We really need structures and systems to minimise them. I have 
            to be honest — when I have presented Isabel’s clinical features to 
            senior paediatricians, not all of them have thought of the more 
            uncommon complications of chickenpox.” 
            
More dramatically, the Isabel system has already proved its 
            worth. Britto says: “We had an infant referred to us last week with 
            swelling in the neck and difficulty breathing. The child had 
            surgical emphysema, where air leaks out to below the skin. 
            
“Afterwards, we found out that somebody, possibly the father, had 
            inserted his finger in the back of the child’s throat and caused a 
            tear in the larynx. This is a very unusual form of child abuse. Most 
            of us would have been hard-pressed to come up with this diagnosis. 
            
“We used Isabel, and it came up with child abuse as one of 
            several possibilities. Had this been available at the bedside, it 
            would have had a huge impact, not just on that child, but other kids 
            from that home. That’s what makes this project so gratifying — it 
            can save so many children’s lives.”