'We want to cut the risk of mistakes'

By Jane Elliott
BBC News Health Reporter

Isabel nearly died

When Jason Maude's daughter nearly died twice after doctors misdiagnosed her, he was determined to do something to stop it happening again.

With the help of a consultant paediatrician he set up a computer system to give medical staff an on-line diagnosis.

Consultants, junior doctors and nurses are able to punch in symptoms and signs before getting a series of options and possible diagnosis.

It acts as a safety net for clinicians - prompting them to consider relevant and probable diagnosis.

Expanded

Now the system, which was initially designed for childhood disorders, is to be extended to include adults as well.

It will cover all the major specialties, including internal medicine, surgery, gynaecology and obstetrics, geriatrics and oncology.

And two new features will help reduce misdiagnosis: the capacity to suggest related diagnoses and recognise conditions and side effects caused by an adverse reaction to specific medicines.

Jason, who now works full time for Isabel Healthcare said his dream is to see it used in all hospitals - and GP surgeries as well.

As a parent you try to work out what has happened Jason Maude

"My dream is that it is also available to every single clinician. We have proved that it works."

Isabel was just three-and-a-half when she fell sick with chickenpox. At first her illness followed the normal patterns, but she failed to improve and developed a fever, vomiting and diarrhoea.

"Everything was shrugged off as chicken pox, but the symptoms got worse and we were told that it was all normal," said Jason.

Her parents took her to accident and emergency, but Isabel deteriorated rapidly.

"They said she looked dehydrated and they tried to take her blood pressure. She went into multiple organ failure.

"Her body was crashing. She had a secondary infection. Then the resuscitation team came in and then said she was 'very sick' which meant she could well die."

She was taken by police escort to St Mary's Hospital, London. There she remained for two months after paediatric specialists diagnosed Toxic Shock Syndrome and Necrotising Fasciitis, the so-called 'flesh-eating bug'.

Thanks to top quality medical care she eventually made a full recovery - and six years later all she has is a scar to remind her of her brush with death.

System

But it was during their time with Isabel in hospital that Jason, wife Charlotte and paediatrician Dr Joseph Britto, came up with the idea for the system.

NHS costs Each year adverse events cost the NHS £2bn through avoidable hospital stays The NHS pays out £400m each year in criminal negligence claim settlements

"As a parent you try to work out what has happened. The hospital said we had not been very well looked after and that the doctors had tunnel vision.

"The first people you see are the least able to diagnose because they are either junior doctors or a GP. They are not equipped to diagnose patients with an unusual presentation."

Jason said it had been noticeable that the doctors who treated Isabel did not use computers - and he felt they were missing out on a potentially valuable source of knowledge.

So he decided to find a way of providing it for them.

Dr Britto gathered the support of a number of colleagues and compiled the diagnostic tool, which has since been validated by the Department of Health. And Jason said he was delighted with it.

"The system is absolutely outstanding. What we are trying to do with the system is a diagnosis reminder system.

"It is as if the junior doctor went to a professor and said I have this patient with this and this and this. It is a tool to help work up a diagnosis - and it does it in a much quicker time."

Dr Britto, who is now medical director of Isabel Healthcare Ltd, said the system was proving extremely useful.

"Hospitals are realising it is essential that investment like this is made to ensure that doctors and nurses have the technology to make accurate diagnoses that help deliver better and safer care to children and adults at the earliest possible stage.

"Isabel uniquely mobilises knowledge into the clinician's workflow and helps answer questions that currently remain unanswered"

Options

Dr Warren Hyer, consultant paediatrician and paediatric gastroenterologist at Northwick Park Hospital, who has used the system since it was created four years ago said it was an invaluable tool, particularly for unusual cases.

"It is like having a senior colleague by our side 24 hours. Somebody who has seen everything.

"I have seen some children with some rare conditions where an average consultant might see one or two a year and Isabel has given me the information within minutes of seeing the patient."

"I probably access it about once a week, but if I am in charge of the acute unit I might be looking at it once a day.

"If you have a child with fever, joint pain, bloody diarrhoea, leg pain you can put that in to the system and it will come up with the information."

The system is currently used in seven NHS hospitals in the UK, four in the US and one in India.

Dr Harvey Marcovitch, paediatrician and spokesman for the Royal College of Paediatrics and Child Health, said: "It is an excellent system because if you are a doctor on duty in a hospital, particularly at night and if you are not particularly experienced. If a child comes in with an unusual problem it is very nerve wracking for you.

"Finding your way through text books is very time consuming and often does not tell you what you want to know whereas Isabel is very quick at dealing with things."