Crowd Wisdom for Diagnosis?

Diane Zuckerman diane at EBSOLUTIONS.COM
Thu Jul 18 23:18:27 UTC 2013


Ted,

What you have stated has been in development since 2006 with a pending patent. If you'd like to discuss, email me. Yes, real-time, real-world. As we know, 70-85% of a Dx is a good Hx & PE. Who knows more about the HPI & PSFH than the patient, and who has the least time to collect that info (MD). Thus patient input is key to comprehensive info and cognitive support for the MD at POC is also paramount to efficiency and improved Dx

Diane Zuckerman, RPh
Founder, CEO, Evidence-Based Solutions
41 East 11th Street
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New York, NY 10003
Cell: 917-256-9620
diane at ebsolutions.com<mailto:diane at ebsolutions.com>
www.ebsolutions.com<http://www.ebsolutions.com>



On Jul 18, 2013, at 2:22 PM, <Ted.E.Palen at KP.ORG<mailto:Ted.E.Palen at KP.ORG>>
 <Ted.E.Palen at KP.ORG<mailto:Ted.E.Palen at KP.ORG>> wrote:

Great discussion.
As medical student I did a rotation with Frank Naeymi-Rad while he was developing the intelligent medical record.  In this early system as the user inputted symptoms and physical exam findings (in a codified manner) it was running DxPlain, Iliad, and QMR in background.  When you finished inputting your data a list of diagnoses was presented in order of probability.  That was 30 years ago.  Unfortunately, as Dr Papier points out, these types of systems were not widely incorporated into electronic medical records.  But imaging if EMR user interfaces for data entry was improved and  if patients entered their own data, and this data was feed to systems like IBMs Watson, Visualdx, or similar systems how much better our cognitive diagnostic abilities could be.  In addition, as more data is collected the systems could become "smarter."  They could also suggest appropriate additional diagnostic or treatments based on the evidence, cost-effectiveness, and track clinical outcomes.  Could this result in being able to do "real-time" comparative effectiveness research.

We have come a long way since my experience with the intelligent medical record but unfortunately we are still not using these kinds of tools and capabilities to actually change the way medicine is practiced.

Ted E. Palen, PhD MD, MSPH | Physician Investigator | Institute for Health Research | Kaiser Permanente Colorado
Physician Manager for Clinical Reporting | Medical Cost Management| Colorado Permanente Medical Group
• 303-614-1215 | 7 303-614-1305 | • ted.e.palen at kp.org<mailto:sarah.madrid at kp.org>

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From:        Art Papier MD <apapier at LOGICALIMAGES.COM<mailto:apapier at LOGICALIMAGES.COM>>
To:        IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Date:        07/18/2013 12:07 PM
Subject:        Re: Crowd Wisdom for Diagnosis?

________________________________



Yes clinical decision support, and using tools at the time of action, instead of relying on memory alone needs to be taught and adopted widely.  Wonderful systems like Dxplain, Iliad, QMR, PKC  were developed 30 years ago or more, but never widely adopted.  Kahneman asserts that System 2 thinking is hard and humans don’t like to spend much time really thinking and being analytical.  Humans actually prefer to not use their brain to think, process and solve!  It is too difficult Kahneman argues, we are lazy and prefer quick, blink type judgements.  In thinking about diagnostic CDS, we need to realize that the output of diagnostic CDS cannot increase cognitive burden, it must make answers more obvious.  So yes we need to create and teach to systems that help the clinician capacity to remember and process, but we must focus on the output of CDS, these systems must relieve cognitive burden and make it easier to see answers.   For anyone on the list that is curious about a different approach to CDS please visit www.visualdx.com<http://www.visualdx.com/>  VisualDx has a 98% renewal rate at hospitals, is used in over half of US medical schools, and over 1500 hospitals and large clinics.   Ten of thousands of clinicians use VisualDx to assist in pattern recognition and diagnosis.   Here is just one example of how CDS is used in busy work environments http://www.visualdx.com/user-stories/gonococcemia  Please feel to contact me off the list with research questions or collaborative ideas.

Art Papier MD, Logical Images,
Associate Professor of Dermatology and Medical Informatics
University of Rochester

From: Hoffer, Edward P.,M.D. [mailto:EHOFFER at PARTNERS.ORG]
Sent: Wednesday, July 17, 2013 2:01 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: Crowd Wisdom for Diagnosis?

I would suggest hat rather than trust to serendipity - ie, someone on the list might have some useful ideas - that doctors with a puzzling case should avail themselves of computer-based clinical decision support systems such as DXplain (visit dxplain.net<http://dxplain.net>) or Isabel.  These have been well-proven to be useful in improving one's differential diagnosis.

Ed

Edward  P Hoffer MD
MGH Lab of Computer Science

________________________________

From: Peggy Zuckerman [peggyzuckerman at GMAIL.COM<mailto:peggyzuckerman at GMAIL.COM>]
Sent: Wednesday, July 17, 2013 12:27 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: Crowd Wisdom for Diagnosis?
Dr. Zamir's suggestion that doctors who are puzzled by a diagnosis and turn to this or similar sites could solve some of the errors  that occur.  Frankly, I am more concerned about the doctor who has made a misdiagnosis, and has no idea that he has done so.

Thus the need for the patient to search out more input into the unresolved issue.  There is little information on the impact of misdiagnosis, but many in this community have personal experience with this.  Multiply that tenfold and you get a sense of the cost to our society.

A friend sums this up in the simple question that floats in the mind of every frustrated patient, "How do I know if my doctor knows what he is talking about?".

Peggy Z

On Wed, Jul 17, 2013 at 7:35 AM, Timothy Krohe <tkrohe1 at gmail.com<mailto:tkrohe1 at gmail.com>> wrote:
Agree with Dr Zamir the better utility of posting to physicians-only services .

While my goal is not to provide a plug,  this type of assistance happens regularly on sermo.com<http://sermo.com/> .  In frequent posts,   a physician  describes a case,  requests help AND usually provides feedback to enhance learning. All posts are visible to all physicians, so there are glimpses of "how (other) doctors think".  Access is free to licensed physicians.  The website has MANY other humor/stress release/political/administrative postings as well so is not purely clinical and you need to sift for the clinically useful posts.

In the DoD, there is a worldwide teleconsult service that emails requests for help , often from the outlying combat or isolated bases. A large group of specialists/internists from the larger military hospitals have responsibility to respond quickly with comments/recommendations.   Very collegial and supportive for those docs/corpsmen/NPs/PAs providing care in isolated area. Access obviously limited to DoD.

I have enjoyed and learned (and I hope helped other MDs) from both systems.  No fees for the reqeuster in either.

TL Krohe MD General Internal Medicine

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