"Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today… At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something….Yet diagnostic software has been slow to make its way into clinical settings, and Dr. Dhaliwal, who uses Isabel as a “second check,” said he could understand why."
- New York Times, Dec 3rd 2012
"A patient presented with arthralgias and diarrhea. He had been seen at other clinics and not diagnosed. I used Isabel and Yersinia Enterocolitica was one of the top diagnoses, a diagnosis I would not have come up with on my own. I felt certain after reviewing the data, his symptoms and prior studies that this is what the patient had. The patient was satisfied with the diagnosis and confident in his prognosis. I use Isabel quite frequently during my patient visits when I am presented with a new diagnostic decision. I open up the interface while I am talking to the patient. I explain what I am doing and what the program does, enter the data, and then discuss the diagnostic suggestions that are presented by Isabel. I find that my patients accept this very well and think of it as “high tech”, they seem generally pleased that I am putting so much consideration into an accurate diagnosis."
- Lawrence Sprecher MD, Midelfort Clinic, Mayo Health System's Luther Midelfort, Eau Claire, WI
"Thanks again for Isabel..I made the diagnosis of X-linked hypophosphatemic rickets as soon as I logged on! Isabel has saved me and a few patients a lot of woe...helped me diagnose Ciguatera poisoning outbreak!"
- Bob Eanett MD, Watson Clinic, Lakeland, FL
"A patient was seen recently at our facility. Necrotizing Fasciitis was not considered as a serious possibility. The surgeon used Isabel and then went back to the patient and decided to take him to the OR. Surgery not just confirmed the diagnosis but allowed the early debridement. Isabel probably saved this patient's life."
- Terrance R. Borman MD, Medical Director, Mayo Health System's Luther Midelfort, Eau Claire, WI
"[Isabel] mines textbooks and journal articles…not only suggest possible diagnoses but link to helpful resources and references."
- Robert M. Wachter MD, Professor and Associate Chairman, Dept. of Medicine, University of California, San Francisco. Chief of the Medical Service UCSF Medical Center. In Understanding Patient Safety - IT Solutions for Improving Diagnostic Accuracy. Published by McGraw-Hill Medical
"There had been software products over the years ... but Isabel was the most sophisticated product I had ever seen."
- Leslie G. Selbovitz, MD, Senior VP for Medical Affairs & CMO, Partners Newton-Wellesley Hospital interviewed
"I love the Isabel system and as a medical student it has really helped my learning."
- Colin Mooney, Medical student, Creighton Medical School, Omaha, Nebraska
"I am impressed with your product which shows the result of careful, effective design and modifications through the years."
- W.L. Williams, MD MPH&TM MBA, Chief Medical Officer, Clinical Effectiveness, Tenet Healthcare Corporation, Dallas, Texas
"As patient records have moved to electronic forms, Isabel has been integrating into these systems. Integration will be critical for the broad adoption of such systems. Isabel, which uses natural language searchers and a real-time synthesis of medical literature is the best thing I've seen out there."
- Richard Chinnock MD, Chairman of Pediatrics at the Loma Linda Children's Hospital, Loma Linda, CA. quoted in Journal of Life Sciences.
"Isabel is a great tool for difficult to diagnose cases!"
- Mary Lynn Allen, MD, Clinical Asst Prof of Internal Medicine, VA- Assoc Chief of Staff of Ambulatory Care, North Florida/South Georgia Veteran Health System - Gainesville, FL
"Isabel suggested the correct diagnosis in 98% cases. Decision-support systems can help doctors avoid falling victim to "premature closure" - the tendency to focus on one diagnosis that seems to explain all of the symptoms, then stop considering other possibilities."
- Mark Graber MD, Chief of Medical Service at the VA, Northport, NY, quoted in the Wall Street Journal
"Isabel program is used to get residents to broaden their thinking and to consider such issues as whether a child with fever and rash should be evaluated not only for infections but also for juvenile rheumatoid arthritis or lupus."
- Professor Margaret K. Hostetter MD, & Physician-in-Chief, Yale University's Yale-New Haven Children's Hospital, NH
"This is really a culture change for doctors. We have to face that we can't really know it all or carry all the medical knowledge in our heads."
- Stephen Borowitz MD, Pediatric Gastroenterology, University of Virginia Children's Hospital, VA
"The Children's Transport and Physician Referral Center has, since 2002, transported over 10,000 children, primarily from Wisconsin, northern Illinois and the upper peninsula of Michigan, but has also traveled across the United States bringing patients to one of the nation's top rated pediatric hospital. The Children's Transport with its mobile ECMO program makes it one of only four transport programs in the country to perform mobile ECMO. Children's Transport is comprised of a Transport Nurse Clinician (TNC) and a Transport Respiratory Care Practitioner (TRCP) for 80-85 percent of all transports and team members are now equipped with wireless handheld devices for clinical decision support and knowledge mobilization on the move.
Children's Transport is impressed not just with the speed and accuracy of the Isabel system delivered on wireless PDAs but also with the ability to remind the team of likely diagnoses at referring facilities so that appropriate treatment can be initiated early in the interhospital transfer process. Isabel will be a wonderful asset for our transport team members to access while in a mobile environment."
- Leslie Talbert RN, Clinical Triage & Transport Services Manager, Children's Hospital of Wisconsin
"We are excited to be evaluating the Isabel system in our pediatric department. It fits well with our philosophy of safe, effective and cost efficient medical care - by having pertinent information resources easily at hand. In addition, we believe that it will be a very valuable tool in teaching the art of diagnosis to pediatric house staff and medical students."
- Richard Chinnock MD, Professor and Chair of Pediatrics, Loma Linda, California
"I am impressed with the concept and its execution. This is an innovative product that I think may soon be proved to have significant clinical utility, particularly if integrated into EMRs so that the system can operate in the background and be selected when needed, with minimal effort from the clinician. In a world of exploding biomedical knowledge, and limited human cognition, the arguments in favor of Isabel and other decision support systems are compelling. I will watch for the peer-reviewed results of further study with great interest. Institutional and individual buyers should definitely give it a look. "
- Gary Kantor, MD, Case Western Reserve University
"Several features I feel are innovative and useful for my practice as a pediatric infectious diseases consultant. The Diagnosis Reminder System is useful to check my differential diagnosis list against. The regional preferences search option is one I like a lot, because of the importance of travel history and geographic exposure patterns to many of my consults. For teaching and communicating with trainees and families, the Lessons Learnt and What's New options give me ready access to potentially interesting PubMed articles. I find Isabel unique and uniquely helpful."
- Jeff Mckinney, M.D. Ph.D, Assistant Professor In Pediatrics and Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
"I am impressed with the power of the Isabel system to remind physicians of a list of likely diagnoses. Isabel's ability to provide diagnosis-specific information very quickly will assist the quality of clinical decision making."
- Sidney M. Gospe, Jr., M.D., Ph.D, Head, Division of Neurology, Children's Hospital & Regional Medical Center, Seattle, USA
"A boy was admitted suffering from acute myelocytic leukemia. He had been seen by several other doctors and two other pediatric oncologists. All signs pointed to acute myelocytic leukemia, and the oncoming physician was prepared to do a bone marrow and start aggressive chemotherapy.I decided to consult Isabel and entered leukemia, neurofibromatosis, and fevers into in the Isabel query box and was surprised to be reminded of Juvenile Chronic Myelogenous Leukemia /Juvenile Myelomonocytic Leukemia. We had not considered this rare diagnosis, which requires a bone marrow transplant. Aggressive chemotherapy would not have been helpful, and potentially very dangerous.The Isabel system prevented a serious error in diagnosis and is likely to have saved this patient's life. I am aware of three other instances in which Isabel made a positive difference to patient care."
- John Bergsagel, MD, Leukemia/Lymphoma Service, Children's Healthcare of Atlanta &Emory University School of Medicine, Georgia, USA
"Isabel is a powerful and wonderful tool that is useful for both advanced clinicians and learners. For the experienced, it can serve as a reminder of the zebras that we sometimes overlook. For learners, it can be used as a tool to help build their differential diagnoses skills. It truly is a gift in caring for patients."
- Joseph H. Schneider, MD, Pediatrician & Chief Medical information Officer, Childrens Medical Center Dallas, Texas, USA
"The Isabel Healthcare program has potential to become a tool which could be useful to physicians in guiding them to consider a variety of diagnoses when confronted with various signs and symptoms."
- Rebecca T. Kirkland, MD, Pediatrician & Head of Clinical Chiefs, Texas Children's Hospital, Texas, USA
"Isabel is a robust database of information and linkages to help clinicians formulate comprehensive lists of differential diagnoses. It's interface is simple and intuitive, and for teaching students and residents, there is nothing comparable. Outstanding in every way!"
- Stanley I. Fisch, MD, Pediatrician, Valley Baptist Health System, Texas, USA
"Coming from the intensive-care unit, a lot of times, things aren't straightforward. The value of Isabel is the fact that they have amassed such a large differential diagnosis that it makes you think about abnormal diagnoses much more. Particularly in communities without substantial medical expertise, it should lead to fewer misdiagnoses, if people take the time to use it.
Physicians can't ignore the fact that we can't remember everything, and we have to learn how to take advantage of tools such as this."
- Neal Thomas, MD, Assistant Professor of Pediatrics and Health Evaluation Sciences at Pennsylvania State University College of Medicine, giving the Isabel system high marks whilst talking to Information Week
I find Isabel so useful in providing patient care and in teaching house officers You are worth your weight in gold. Thank you for such an informative website.
- Margaret K. Hostetter, MD, Professor and Chair, Department of Pediatrics Physician-in-Chief, Yale-New Haven Children's Hospital Yale University School of Medicine. USA
Since discovering this website, I have listed the main clinical characteristics of every medical admission to our PICU for the past month and Isabel has included the correct diagnosis in every caseThe owners of this website have set a new standard for implementing a real-time clinical tool that is available and useable for pediatric clinicians. I highly recommend this tool to anyone who is involved in the care of critically ill children.The diagnostic tool section is unmatched in scope and simplicity of use. It is foreseeable that Isabel may save a critically ill child from a potentially catastrophic delay in diagnosis.
- Neal J Thomas MD, Assistant Professor of Pediatrics, Pennsylvania State University College of Medicine. Quoted in Critical Care
"Isabel ensures that I consider the broadest of differential diagnoses and prevents diagnostic tunnel vision."
- Andrew Winrow MD, Consultant Paediatrician and Clinical Director, Kingston Hospital NHS Trust
"Isabel is 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 diarrhea, leg pain you can put that in to the system and it will come up with the information."
- Dr.Warren Hyer, Consultant Pediatrician and Pediatric Gastroenterologist, Northwick Park Hospital, London UK, who has used Isabel since it was created four years ago talking to BBC News
"Isabel 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."
- Dr. Harvey Marcovitch, Pediatrician and spokesman for the Royal College of Pediatrics and Child Health, UK talking to BBC News.
"Isabel can trigger conditions that a doctor may not have thought of but doctors will always tend to trust their instinct first. It is not a natural instinct for a doctor to look something up on a computer. They are much more likely to check something with a colleague verbally. Isabel has a better memory than humans and is a useful tool for cases that are difficult to diagnose."
- Dr. Mike Coren, Consultant Pediatrician, St. Mary’s Hospital, London, UK, talking to CNN.com
A very hearty thanks to all at Isabel for this excellent and invaluable tool. Its accessible, user friendly and a must for every A&E and Pediatric department. It has definitely made me think of other possible diagnoses and investigations that could have been missed without it. I have found it useful as an educational tool providing easy access any time or place in the hospital setting to gain theoretical knowledge.
- Dr. Jimmy Abraham, Senior House Officer, London,