Hannah Rutledge, PhD, MLIS, AHIP
Head of Clinical Informationist Services
Woodruff Health Sciences Center Library
Emory University

Overview

In 1999, a 3-year-old patient’s chicken pox progressed undetected into necrotizing fasciitis and toxic shock syndrome. Misdiagnosed by her family doctor and hospital clinicians, the patient spent two months in the hospital struggling to survive from multiple organ failure and cardiac arrest. Her parents were told that “clinical ignorance” was to blame; the junior doctors did not know that necrotizing fasciitis was a complication of chicken pox.

As a result, her parents decided to create a tool to assist doctors with diagnoses and named it after their daughter, Isabel. Twenty years later, Isabel is an active college student, and medical professionals around the world access the differential diagnosis tool that bears her name.

Isabel Pro, one of several products offered by Isabel Healthcare, is a differential diagnosis generator designed to ensure no diagnosis is overlooked.

Content

Isabel Pro is a web-based program designed for clinicians making a diagnosis, as well as medical students and residents honing their skills. It can assist in thinking through all possibilities in any case with diagnostic uncertainty.

The differential diagnosis process begins by entering patient data (age, gender, travel history) into the “clinical features” box on the homepage. Next, the user enters any abnormal clinical features, including chief complaint, labs, vitals, comorbidities. Clicking the “Get Checklist” button generates a ranked diagnoses list organized by a color bar or “Likelihood Indicator:” dark orange designating “most likely” through the light yellow “less likely.” The list can be sorted by specialty or by red flags (conditions requiring immediate attention). Another tab lists drugs whose side effects may cause the symptoms.

Clicking on a possible diagnosis brings up a separate window – the “knowledge window” – containing evidence-based information on that particular condition. Information is pulled from online resources such as Merck Manual, MedlinePlus, and PubMed, as well as major publishers that partner with Isabel: DynaMed Plus (EBSCO), 5Minute Consult (Wolters Kluwer), and BMJ Best Practice. Additional resources can be added to the knowledge window, including subscription resources available at the institution.

Features and Functionality

Isabel Pro, which boasts a 96 percent accuracy rate, applies artificial intelligence pattern recognition software onto a database of more than 10,000 diagnosis presentations for all ages and all specialties. There can be a learning curve in regards to entering clinical features, but Isabel Healthcare representatives are available to provide training and support.

Searching

On the left side of the homepage is the “clinical features” box in which the differential diagnosis process is produced. On the right side, there are two search boxes enabling Isabel Pro to be used for basic searching needs. One search box directly and seamlessly searches DynaMed Plus for evidence-based knowledge.

The other search box is a “knowledge search,” whose information is pulled up in a knowledge window with the predetermined subscription and nonsubscription resources available.

Email / Print / Save / Copy

For every differential diagnosis search generated, there is the capability to email, print, save, or copy the results. These options are listed to the right of the ranked diagnoses box. A feedback button is also available.

Mobile App      

Although there is no separate app available for Isabel Pro, mobile access is available by saving a shortcut to the web interface on the device’s home screen.

Integration into EMR

Isabel Pro can be fully integrated into the EMR. The cost is dependent upon the degree of integration – a link in one or more areas versus seamless integration.

Business Model

Subscriptions are offered on individual and institutional levels. Individuals can purchase a standard package subscription for $149.99 or a premium package for $219.99. The premium package includes access to 5Minute Consult. Discounts are available to students, medical students, and to those from countries designated as Emerging Economy Nations (EEN).

Institutions should contact Isabel Healthcare representatives for pricing. Thirty-day free trials are also available. For institutional subscribers, there is one user name and one password for access across the institution. Usage data is available upon request, organized by month. It also clarifies IP and mobile usage.

Other products available from Isabel Healthcare include Isabel Symptom Checker (for patients), Isabel Active Intelligence (for full EMR integration) and Isabel Clinical Educator.

Breakthrough

Isabel Pro is a diagnostic tool that can be accessed quickly and easily at the bedside, in morning reports, or even in case conferences for resident education. It is designed to help clinicians think outside the box in difficult cases and to provide a list of diagnostic possibilities when there is any uncertainty. Isabel Healthcare’s website provides insightful data, validations, and testimonials to its impact. As a standalone tool or imbedded in the EMR, this differential diagnosis generator can truly assist clinicians, residents, and medical students in making or confirming a diagnosis.

Reference

Isabel Healthcare. Isabel Pro – the DDx Generator. Retrieved from https://isabelhealthcare.com/products/isabel-pro-ddx-generator.