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Live from HIMSS: Making the Case for a Diagnosis Decision Support

February 21, 2012
by Gabriel Perna
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One healthcare provider has implemented a diagnosis decision support system in order to help get it right at the initial point of care

With 20-plus years of experience in the medical informatics field, Khalid Moidu, MD, PhD, director of medical informatics at Orlando Health, has seen a lot. As a physician and someone with a PhD in clinical informatics, Dr. Moidu can safely say he sees both sides of HIT implementation, clinical and IT, within the walls of a hospital.

At this week’s HIMSS12 conference in Las Vegas, Moidu discussed with HCI how seeing both sides allowed him to successfully push for a diagnosis decision support system (DDSS) within Orlando Health and get physicians in the 1,780-bed family of facilities to buy in. A DDSS is an application platform that can be integrated into an EMR. It aims to help physicians diagnose a patient right off the bat by assisting them with possible diagnoses, based on symptoms, through links to clinical literature resources available in and outside of a hospital.

To get leadership at Orlando Health to buy into a DDSS, Moidu and his team said the best time for a physician to learn what is right, is that first diagnose because it stays in their mind forever. “Then it becomes a real teaching moment,” he states. He says the system creates a vision for a physician of possibility rather than what is the probability.

In terms of physician buy-in, Moidu admits if he didn't have a physician background, it may have been harder, but with his background, there wasn't an issue. Utilization of the service has gone up significantly since implementation. “We never got 200 hits (online views) per month on medical journals, now we get on an average weekly basis, one thousand hits,” he says. The tool, he notes, allows physicians to think of the 5th, 6th, and 7th variable that they might have otherwise thought.

Orlando Health has worked with Ann Arbor, Mich.-based Isabel Healthcare, a vendor in the DDSS field, in implementation.  Because of HL7 standards and Isabel’s application performance interfaces (APIs), it was able to integrate the system into Orlando’s EMR, AllScripts’ (Chicago, Ill.) Sunrise Clinical Manager. In fact, Isabel claims it can integrate the system into any EMR.

The story behind Isabel Healthcare’s creation is not exactly heart-warming, but according to founder and CEO Jason Maude, showed the need for a DDSS system. He explains the company came about after his three year old daughter Isabel was nearly fatally diagnosed her local hospital. The doctors assumed Isabel’s symptoms were chicken pox, which she was suffering from at the time, but in reality she had a secondary infection: Necrotising Fasciitis.

After a period of time in intensive care and on the high dependency unit, she was able to fight through and survive.  From that experience Maude created Isabel, which he says can be described as a “fast gateway to knowledge.” On top of providing the DDSS platform, Isabel has teamed with several medical journals, including a recently announced relationship with EBSCO Publishing’s DynaMed, to provide information at that initial point of care.

For Moidu, the implementation of the DDSS and what it brings to the tablet supports his favorite punch-line in the industry. “Health informatics is about variance, variations and variability,” he says. “People think they mean the same thing, that’s wrong, they have deep meanings. That is where you have to bring in the challenge of communicating a little better.”