“It all exists,” said Dr. Art Papier, CEO of Logical Images, “but it's not being used everywhere and a lot of people don't even know about it.”
A barrier to the broader use of such diagnostic support tools is their lack of full integration with providers' existing electronic health-record systems, according to several experts.
At Children's Hospital and Medical Center in Omaha, Neb., Isabel has been available to clinicians since 2012.
“I think it's a great tool,” said Dr. George Reynolds, its vice president, chief information officer and chief medical informatics officer. “I remain a little frustrated that it's not used more widely within my own organization. The main target for the tool for us is the residents and nurse practitioners in training. Like anybody else, they're struggling with time pressures. It's not always easy. The next generation for these tools needs to present the data more proactively and more intuitively, and that's a real challenge.”
Dr. Brian Patty, vice president and CMIO of the HealthEast Care System in Minneapolis, has begun planning a pilot project to integrate Isabel, which has been in use there for about a year, into its EHR from Epic Systems.
To use the tool today, Patty said, HealthEast physicians have to go to a website and enter patient data. The goal of the pilot is to have Isabel “sit in the background and look at data elements about the patient,” Patty said. “Then, at some point during the workflow, it would take a look at what the provider has already entered in the problem list, and if there is a high-probability on the problem list the provider hadn't worked up, it would fire off an alert, saying, consider these other diagnoses.”
Full, seamless EHR integration would overcome two barriers to adoption by busy doctors: having to think about using the tool in the first place, and re-entering patient information already in an EHR, Patty said.
“Diagnostic error is one of the biggest causes of patient harm today,” Patty said. “By enabling something to look in the background to suggest possible alternatives, we're going to lesson those incidents of diagnostic error.”
While advocates say diagnostic systems could help spot future Ebola patients, Feldman and Reynolds countered that the Texas death and the media coverage around it have raised everyone's awareness levels already.
“Everybody and his brother, including us, is writing an alert,” Reynolds said, programming computer systems to fire off electronic warnings when fever and a travel history to West Africa are entered in the electronic record.
Whether the Ebola outbreak will be a watershed event in the adoption of electronic diagnostic support is still in question.
“It's coming slowly,” said Jason Maude, the founder of Isabel, named after his daughter, who was injured as an infant by a missed diagnosis of necrotizing fasciitis.
In addition to Ebola, according to Maude, another factor that could push adoption of diagnostic support systems is a research project underway on diagnostic errors by the Institute of Medicine. A report is due next summer.
“The issue of diagnosis is getting more important,” he said. “The tools are there. They're proven to work. They're accessible, they're cheap.”
The “complete” version of VisualDX for Apple and Android smart phones, for example, is available for $29.99 a month. Hospitals pay based on the number of users as well, but at a discount.
In the Duncan case, Texas Health Presbyterian Dallas initially pointed fingers at its EHR, from Epic, saying a flaw contributed to miscommunication between a nurse and a physician who saw Duncan, but the hospital quickly walked back that statement. The hospital has not responded to a request asking whether computerized diagnosis systems were available or in use there at the time Duncan walked into its emergency room for the first time in late September.
Follow Joseph Conn on Twitter: @MHJConn
