SIDM Tech Update: HIT for Diagnosis

Art Papier apapier at VISUALDX.COM
Sat Mar 11 22:13:46 UTC 2017


To properly attribute Charles Friedman PhD :  Brain + Computer > Computer 

 

“A  Fundmental Theorem of Medical Informatics”

https://academic.oup.com/jamia/article/16/2/169/959379/A-Fundamental-Theorem-of-Biomedical-Informatics 

 

Art Papier MD

CEO VisualDx

Associate Professor of Dermatology and Medical Informatics

University of Rochester College of Medicine

  

 

 

 

 

From: Edward Winslow [mailto:edbjwinslow at GMAIL.COM] 
Sent: Wednesday, March 08, 2017 12:30 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] SIDM Tech Update: HIT for Diagnosis

 

Amos, 

Thanks for forwarding this to us. Certainly the members of SIDM will be interested in your paper.

We look forward to keeping up to date on progress in CDSSs and how they may contribute to improving our cognitive processes. One of the members of the board of directors of SIDM has proposed the construct:

           Human Brain + Computer > Human Brain or Computer.

As computers and computer learning progress, we look forward to advances in the Brain + Computer collaboration.

Regards,

Ted

 

On Wed, Mar 8, 2017 at 10:04 AM, Amos Cahan <acahan at us.ibm.com <mailto:acahan at us.ibm.com> > wrote:

Dear Dr. Winslow,

In a paper published today in JMIR (http://www.jmir.org/2017/3/e54/), we review the shortcomings of current computer-aided diagnosis support systems and suggest a framework for the development of "next generation" DSS. 

The approach we advocate for involves structured representation of knowledge, sharing of automatically-deidentified clinical data and a knowledge base associating patient presentation patterns with the diagnosis assigned to them. It further uses disease base rate to evaluate the probability of a diagnosis given a compatible clinical presentation. We believe this approach will enable recruiting the collective clinical experience of physicians to help diagnose new patients.

I thought this might be of interest to community members. 

Best,

Amos

Amos Cahan, MD
Research scientist, Clinical Informatics
IBM T. J. Watson Research Center
1101 Kitchawan Road, Route 134
Yorktown Heights, NY 10598
1.914.945.2590 <tel:(914)%20945-2590> 
acahan at us.ibm.com <mailto:acahan at us.ibm.com>  



Edward Winslow ---02/16/2017 03:56:17 PM---*Health Information Technology (HIT) Tools for Diagnosis:* In November, we posted a call for IT or i

From: Edward Winslow <edbjwinslow at GMAIL.COM <mailto:edbjwinslow at GMAIL.COM> >
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG> 
Date: 02/16/2017 03:56 PM
Subject: [IMPROVEDX] SIDM Tech Update: HIT for Diagnosis

  _____  

 

Health Information Technology (HIT) Tools for Diagnosis:


 

In November, we posted a call for IT or ideas you have for improving diagnosis. These tools are often referred to as either:

*      Medical Diagnostic Decision Support Systems (MDDSSs) 

*      Diagnostic Clinical Decision Support Tools (DCDSTs)

 

Laura Zwaan in her article in our journal ( <https://www.degruyter.com/view/j/dx.2014.1.issue-1/dx-2013-0018/dx-2013-0018.xml?format=INT> Diagnosis; 2014, 1, 139-141) suggested that, properly devised and used, health IT should help improve the diagnostic process and that information about such tools should be widely disseminated. 

 

Here are the 4 tools submitted in response; all are commercially available, and listed by date of introduction. Each of the submissions were from representatives of the organization that created the tools.

 

DXplain (http://www.mghlcs.org/projects/dxplain) - Submitted by Edward P Hoffer, MD (ehoffer at gmail.com <mailto:ehoffer at gmail.com> ): 

DXplain, a MDDSS developed and supported by the Lab of Computer Science at the Massachusetts General Hospital, was first released in 1987, with 500 diseases in the database (db). Over the ensuing decades it has evolved and expanded to its current database of over 2500 diseases and some 6000 “findings,” which include symptoms, physical findings, demographics, laboratory test results and imaging findings. Its most common use allows the student or clinician to enter information about a patient and receive a rank-ordered list of diseases that can explain the findings entered.  
The system was designed to be transparent, and will explain why a disease is on the list. It can guide the user to enter additional findings that will refine the disease list. Uniquely, it allows the entry of negatives – ie, absence of findings, which often help exclude diseases that would otherwise be suggested. The user can interrogate the db to get disease descriptions and diseases associated with any finding. Each disease has a hand-selected set of good references and also facilitates PubMed and Google searches. Many of the findings have associated descriptive text to describe their meaning.  
DXplain is available world-wide over the Internet by annual subscription and is used by hospital, group practices and medical schools. Full details are available at dxplain.net <http://dxplain.net/>  

Isabel (http://www.isabelhealthcare.com/ ) – Submitted by Jason Maude (Jason.maude at isabelhealthcare.com <mailto:Jason.maude at isabelhealthcare.com>  ): 

The Isabel DDx Generator is powered by statistical natural language processing software applied to a database of disease presentations. The system covers 10,000 conditions, all ages and all specialty areas of medicine. Besides clinical features, Isabel utilizes additional algorithms to only present those results relevant to the patient’s age, gender and geographic region.
The Isabel Symptom Checker uses the medically validated Isabel system. This enables patients to enter multiple symptoms in everyday language. Suggested possible diagnoses are linked to further knowledge. A ‘Where now?’ (triage) feature is also provided to help patients decide where to seek care within a health system.

We subsequently learned that any healthcare professional can take a 10-day free trial of the DDx Generator. There is also a “free patient version” – “Symptom Checker <http://symptomchecker.isabelhealthcare.com/home/main> ” available

VisualDx (https://www.visualdx.com/)– Submitted by Art Papier, MD (apapier at visualdx.com <mailto:apapier at visualdx.com> ) 
In 2016, VisualDx transformed from a dermatology app to diagnostic support for general medicine. 
VisualDx is a web-based diagnostic decision support system improving diagnostic accuracy at the point of care. Through its medical image library and its search technology, health care professionals can build a custom differential. VisualDx introduced the “Sympticon,” a graphical method to communicate the pattern of symptoms. This process encourages a logical method of clinical reasoning and a visual approach to review, compare, and understand variations of disease.  
Available on the desktop, as a native IOS or Android mobile app, and through the electronic health record, VisualDx fits into the clinicians’ workflow. VisualDx uses FHIR inside of Cerner Millennium EHR, and can integrate inside of Epic and other EHR’s.
To understand the approach, please view sample differentials at the link above
30-day free trials are available to students, residents, and any healthcare professional.

Xebra (https://www.physiciancognition.com/) Submitted by Vipindas Chengat, MD (syncopesystem at gmail.com <mailto:syncopesystem at gmail.com> ) 
Physician Cognition’s decision-support and clinical education tools are driven by its core technology, Xebra™, an engine designed to mimic the cognitive strategies of a clinician. Xebra combines a variety of statistical and data analysis strategies to replicate the problem-solving approach taught by many medical schools. Xebra can process any number and combination of symptoms, signs, labs, medications, and past medical history and present a differential list in the order of probability, but its goal is not to offer a definitive diagnosis Rather it is to support the clinician’s decision-making process with a checklist approach. Part of Xebra’s core capability is its workup guide, which can help the clinician refine the diagnosis through an evidence-based step-wise process. 
Physician Cognition’s products are targeted toward clinician students, residents, nurse practitioners and physician assistants to facilitate further learning and critical thinking development. While all products provide pre-searched and direct access to relevant educational resources, XebraPro and XebraED also incorporate both public and private clinician social media platforms to facilitate the discussion of unique and challenging cases, as well as workup guides. 
The company also has ongoing R&D projects with various academic institutions to investigate integration of Xebra decision-support tools with EHRs.

 On a Google and Pub Med search we were able to identify several other systems with potential for being used as a DCDST:

1.     The  <http://www.openclinical.org/> Open Clinical Website has links to some diagnostic tools

2.      <http://www.openclinical.org/dm_lexmed.html> LeXMED (Learning EXpert Systems for MEdical Diagnosis)

a.     Primarily for Diagnosis of abdominal pain.

3.      <http://www.copal-sante.fr/aidediag/#/home> AideDiag, in French

4.      <http://www.connan.jp/examples/en/syoujou1.jsp> CACDDST (Computer-Aided Clinical Diagnostic Decision Support Tool)

5.     Up to Date: Available on most University Library Websites 

 

This is an evolving field. Some DDSS’s that were available in 2011[1] no longer have active websites.

 

To date, it is not yet clear if any of these DCDSTs can be imbedded into existing EMRs/EHRs for seamless use by clinicians desiring an integrated DCDS.

 

We welcome any comments on this topic, which will go through the usual SIDM ListServe review process.

 

  _____  

[1] Bond, WF, et al: Differential Diagnosis Generators: an Evaluation of Currently Available Computer Programs: J Gen Intern Med, 2011, 000027, 213-9



-- 
Edward B, J. Winslow, MD, MBA
Home 847 256-2475 <tel:(847)%20256-2475> ; Mobile 847 508-1442 <tel:(847)%20508-1442> 
 <mailto:edbjwinslow at gmail.com> edbjwinslow at gmail.com
 <http://winslowmedical.com/> winslowmedical.com

"The only thing new in the world is the history that you don't know"
       Harry S. Truman, 33rd President of US (1945-1953)
  

"... it can be argued that underinvestment in assessing the past is likely to
lead to faulty estimates and erroneous prescriptions for future action."
        Eli Ginzberg, 1997

 

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-- 

Edward B, J. Winslow, MD, MBA
Home 847 256-2475; Mobile 847 508-1442
edbjwinslow at gmail.com <mailto:edbjwinslow at gmail.com> 

winslowmedical.com <http://winslowmedical.com> 

 

"The only thing new in the world is the history that you don't know"
       Harry S. Truman, 33rd President of US (1945-1953)
  

"... it can be argued that underinvestment in assessing the past is likely to
lead to faulty estimates and erroneous prescriptions for future action."
        Eli Ginzberg, 1997

 

 

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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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