In 2012, a preteen entered the emergency department at Children's National Medical Center in Washington, D.C., with a high fever, weight loss and diarrhea. The attending pediatrician suspected a rare, travel-related infectious disease, as the child had just been in Southeast Asia.
Specialists combed through the Centers for Disease Control and Prevention website for health alerts from the region. They ran tests. All came back negative.
Only after two days did the hospital turn to a diagnostic decision-support software program called Isabel. Once a clinician typed in the child's symptoms, a list of potential conditions popped up within seconds.
The specialists quickly realized their initial mistake. “Biased by the patient's travel history, we didn't consider a pretty straightforward diagnosis,” recalled Dr. Paul Manicone, associate chief of the hospitalists division for Children's National Health System. Isabel directed the team's attention to hyperthyroidism, a condition they had overlooked.
Software programs such as Isabel have been available for decades. “And they have been underutilized for decades,” said Dr. Mark Graber, a member of the National Academy of Medicine's Committee on Diagnostic Error in Healthcare. “That's the real shame.”
In September, the committee called diagnostic mistakes a persistent blind spot amid efforts to improve quality and safety in healthcare settings. The report recommended research into computer-assisted diagnosis technology.
Diagnosis-assist programs are particularly helpful in difficult or rare cases. Users enter symptoms, such as fever, abdominal pain and skin rash, and patient characteristics, such as medical history and gender. The software generates a list of diagnoses and ranks them in order of likelihood.