"Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical
medicine at the University of California, San Francisco, is considered one of the most skillful clinical
diagnosticians in practice today… At work he occasionally uses a diagnostic checklist program called
Isabel,
just to make certain he hasn’t forgotten something….Yet diagnostic software has been slow to make its way into
clinical settings, and Dr. Dhaliwal, who uses Isabel as a “second check,” said he could understand why."
"A patient presented with arthralgias and diarrhea. He had been seen at other
clinics and not diagnosed. I used Isabel and Yersinia Enterocolitica was one of the top diagnoses, a
diagnosis I
would not have come up with on my own. I felt certain after reviewing the data, his symptoms and prior studies
that this is what the patient had. The patient was satisfied with the diagnosis and confident in his prognosis.
I use Isabel quite frequently during my patient visits when I am presented with a new diagnostic
decision. I
open up the interface while I am talking to the patient. I explain what I am doing and what the program does,
enter the data, and then discuss the diagnostic suggestions that are presented by Isabel. I find that my
patients accept this very well and think of it as "high tech", they seem generally pleased that I am putting so
much consideration into an accurate diagnosis."
"A patient was seen recently at our facility. Necrotizing Fasciitis was not
considered as a serious possibility. The surgeon used Isabel and then went back to the patient and
decided to
take him to the OR. Surgery not just confirmed the diagnosis but allowed the early debridement. Isabel
probably
saved this patient's life."
"There had been software products over the years ... but Isabel was the
most
sophisticated product I had ever seen."
- Leslie G. Selbovitz, MD, Senior VP for Medical Affairs & CMO,
Partners Newton-Wellesley Hospital interviewed
"I love the Isabel system and as a medical student it has really helped my
learning."
- Colin Mooney, Medical student, Creighton Medical School, Omaha,
Nebraska
"I am impressed with your product which shows the result of careful, effective
design and modifications through the years."
- W.L. Williams, MD MPH&TM MBA, Chief Medical Officer, Clinical
Effectiveness, Tenet Healthcare Corporation, Dallas, Texas
"As patient records have moved to electronic forms, Isabel has been
integrating
into these systems. Integration will be critical for the broad adoption of such systems. Isabel, which
uses
natural language searchers and a real-time synthesis of medical literature is the best thing I've seen out
there."
- Richard Chinnock MD, Chairman of Pediatrics at the Loma Linda
Children's Hospital, Loma Linda, CA. quoted in Journal of Life Sciences.
"Isabel is a great tool for difficult to diagnose cases!"
- Mary Lynn Allen, MD, Clinical Asst Prof of Internal Medicine, VA-
Assoc Chief of Staff of Ambulatory Care, North Florida/South Georgia Veteran Health System -
Gainesville, FL
"Isabel suggested the correct diagnosis in 98% cases. Decision-support
systems
can help doctors avoid falling victim to "premature closure" - the tendency to focus on one diagnosis that
seems to explain all of the symptoms, then stop considering other possibilities."
- Mark Graber MD, Chief of Medical Service at the VA, Northport,
NY, quoted in the Wall Street Journal
"Isabel program is used to get residents to broaden their thinking and to
consider such
issues as whether a child with fever and rash should be evaluated not only for infections but also for
juvenile
rheumatoid arthritis or lupus."
- Professor Margaret K. Hostetter MD, & Physician-in-Chief, Yale
University's Yale-New Haven Children's Hospital, NH
"This is really a culture change for doctors. We have to face that we can't
really know it all or carry all the medical knowledge in our heads."
- Stephen Borowitz MD, Pediatric Gastroenterology, University of
Virginia Children's Hospital, VA
"The Children's Transport and Physician Referral Center has, since 2002,
transported over 10,000 children, primarily from Wisconsin, northern Illinois and the upper peninsula of
Michigan, but has also traveled across the United States bringing patients to one of the nation's top rated
pediatric hospital. The Children's Transport with its mobile ECMO program makes it one of only four transport
programs in the country to perform mobile ECMO. Children's Transport is comprised of a Transport Nurse
Clinician (TNC) and a Transport Respiratory Care Practitioner (TRCP) for 80-85 percent of all transports and
team members are now equipped with wireless handheld devices for clinical decision support and knowledge
mobilization on the move.
Children's Transport is impressed not just with the speed and accuracy of the
Isabel
system delivered on wireless PDAs but also with the ability to remind the team of likely diagnoses at
referring facilities so that appropriate treatment can be initiated early in the interhospital transfer
process. Isabel will be a wonderful asset for our transport team members to access while in a mobile
environment."
- Leslie Talbert RN, Clinical Triage & Transport Services Manager,
Children's Hospital of Wisconsin
"We are excited to be evaluating the Isabel system in our pediatric
department.
It fits well with our philosophy of safe, effective and cost efficient medical care - by having pertinent
information resources easily at hand. In addition, we believe that it will be a very valuable tool in teaching
the art of diagnosis to pediatric house staff and medical students."
- Richard Chinnock MD, Professor and Chair of Pediatrics, Loma
Linda, California
"I am impressed with the concept and its execution. This is an innovative product
that I think may soon be proved to have significant clinical utility, particularly if integrated into EMRs so
that the system can operate in the background and be selected when needed, with minimal effort from the
clinician. In a world of exploding biomedical knowledge, and limited human cognition, the arguments in favor
of Isabel and other decision support systems are compelling. I will watch for the peer-reviewed results
of
further study with great interest. Institutional and individual buyers should definitely give it a look."
- Gary Kantor, MD, Case Western Reserve University
"Several features I feel are innovative and useful for my practice as a pediatric
infectious diseases consultant. The Diagnosis Reminder System is useful to check my differential diagnosis
list against. The regional preferences search option is one I like a lot, because of the importance of travel
history and geographic exposure patterns to many of my consults. For teaching and communicating with trainees
and families, the Lessons Learnt and What's New options give me ready access to potentially interesting PubMed
articles. I find Isabel unique and uniquely helpful."
- Jeff Mckinney, M.D. Ph.D, Assistant Professor In Pediatrics and
Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
"I am impressed with the power of the Isabel system to remind physicians
of a
list of likely diagnoses. Isabel's ability to provide diagnosis-specific information very quickly will
assist
the quality of clinical decision making."
- Sidney M. Gospe, Jr., M.D., Ph.D, Head, Division of Neurology,
Children's Hospital & Regional Medical Center, Seattle, USA
"A boy was admitted suffering from acute myelocytic leukemia. He had been seen by
several other doctors and two other pediatric oncologists. All signs pointed to acute myelocytic leukemia, and
the oncoming physician was prepared to do a bone marrow and start aggressive chemotherapy.I decided to consult
Isabel and entered leukemia, neurofibromatosis, and fevers into in the Isabel query box and was
surprised to
be reminded of Juvenile Chronic Myelogenous Leukemia /Juvenile Myelomonocytic Leukemia. We had not considered
this rare diagnosis, which requires a bone marrow transplant. Aggressive chemotherapy would not have been
helpful, and potentially very dangerous.The Isabel system prevented a serious error in diagnosis and is
likely
to have saved this patient's life. I am aware of three other instances in which Isabel made a positive
difference to patient care."
- John Bergsagel, MD, Leukemia/Lymphoma Service, Children's
Healthcare of Atlanta &Emory University School of Medicine, Georgia, USA
"Isabel is a powerful and wonderful tool that is useful for both advanced
clinicians and learners. For the experienced, it can serve as a reminder of the zebras that we sometimes
overlook. For learners, it can be used as a tool to help build their differential diagnoses skills. It truly
is a gift in caring for patients."
- Joseph H. Schneider, MD, Pediatrician & Chief Medical information
Officer, Childrens Medical Center Dallas, Texas, USA
"The Isabel Healthcare program has potential to become a tool which could
be
useful to physicians in guiding them to consider a variety of diagnoses when confronted with various signs and
symptoms."
- Rebecca T. Kirkland, MD, Pediatrician & Head of Clinical Chiefs,
Texas Children's Hospital, Texas, USA
"Isabel is a robust database of information and linkages to help
clinicians
formulate comprehensive lists of differential diagnoses. It's interface is simple and intuitive, and for
teaching students and residents, there is nothing comparable. Outstanding in every way!"
- Stanley I. Fisch, MD, Pediatrician, Valley Baptist Health System,
Texas, USA
"Coming from the intensive-care unit, a lot of times, things aren't
straightforward. The value of Isabel is the fact that they have amassed such a large differential
diagnosis
that it makes you think about abnormal diagnoses much more. Particularly in communities without substantial
medical expertise, it should lead to fewer misdiagnoses, if people take the time to use it.
Physicians can't ignore the fact that we can't remember everything, and we have to learn
how to take advantage of tools such as this."
- Neal Thomas, MD, Assistant Professor of Pediatrics and Health
Evaluation Sciences at Pennsylvania State University College of Medicine, giving the Isabel system high
marks
whilst talking to Information Week
I find Isabel so useful in providing patient care and in teaching house
officers
You are worth your weight in gold. Thank you for such an informative website.
- Margaret K. Hostetter, MD, Professor and Chair, Department of
Pediatrics Physician-in-Chief, Yale-New Haven Children's Hospital Yale University School of Medicine. USA
Since discovering this website, I have listed the main clinical characteristics
of every medical admission to our PICU for the past month and Isabel has included the correct diagnosis
in
every caseThe owners of this website have set a new standard for implementing a real-time clinical tool that
is available and useable for pediatric clinicians. I highly recommend this tool to anyone who is involved in
the care of critically ill children.The diagnostic tool section is unmatched in scope and simplicity of use.
It is foreseeable that Isabel may save a critically ill child from a potentially catastrophic delay in
diagnosis.
- Neal J Thomas MD, Assistant Professor of Pediatrics, Pennsylvania
State University College of Medicine. Quoted in Critical Care
"Isabel ensures that I consider the broadest of differential diagnoses and
prevents diagnostic tunnel vision."
- Andrew Winrow MD, Consultant Paediatrician and Clinical Director,
Kingston Hospital NHS Trust
"Isabel is an invaluable tool, particularly for unusual cases. It is like
having
a senior colleague by our side 24 hours. Somebody who has seen everything. I have seen some children with some
rare conditions where an average consultant might see one or two a year and Isabel has given me the
information within minutes of seeing the patient. I probably access it about once a week, but if I am in
charge of the acute unit I might be looking at it once a day. If you have a child with fever, joint pain,
bloody diarrhea, leg pain you can put that in to the system and it will come up with the information."
- Dr.Warren Hyer, Consultant Pediatrician and Pediatric
Gastroenterologist, Northwick Park Hospital, London UK, who has used Isabel since it was created four
years
ago talking to BBC News
"Isabel is an excellent system because if you are a doctor on duty in a
hospital,
particularly at night and if you are not particularly experienced. If a child comes in with an unusual problem
it is very nerve wracking for you. Finding your way through text books is very time consuming and often does
not tell you what you want to know whereas Isabel is very quick at dealing with things."
- Dr. Harvey Marcovitch, Pediatrician and spokesman for the Royal
College of Pediatrics and Child Health, UK talking to BBC News.
"Isabel can trigger conditions that a doctor may not have thought of but
doctors
will always tend to trust their instinct first. It is not a natural instinct for a doctor to look something up
on a computer. They are much more likely to check something with a colleague verbally. Isabel has a
better
memory than humans and is a useful tool for cases that are difficult to diagnose."
- Dr. Mike Coren, Consultant Pediatrician, St. Mary’s Hospital,
London, UK, talking to CNN.com
A very hearty thanks to all at Isabel for this excellent and invaluable
tool. Its
accessible, user friendly and a must for every A&E and Pediatric department. It has definitely made me think
of other possible diagnoses and investigations that could have been missed without it. I have found it useful
as an educational tool providing easy access any time or place in the hospital setting to gain theoretical
knowledge.
- Dr. Jimmy Abraham, Senior House Officer, London,
