Software Backstops Doctors to Cut Errors
Howard Pierce was in Tampa, Fla., demonstrating his company’s software for helping doctors make diagnoses, when one physician asked for help on an especially vexing case.
A middle-aged woman had odd swelling on her right side, specifically around her shoulders and lips, explained Dr. Willard S. Harris, chief of medical service at the James A. Haley Veterans’ Hospital in Tampa. The patient had been treated for the condition several times over two years, but doctors couldn’t figure out what was wrong.
Harris didn’t tell Pierce, CEO of Burlington’s PKC Corp., that the puzzle had already been solved by a second-year resident at Tampa General Hospital, where the woman was treated. She had a rare inherited disorder that is easily treatable but potentially life-threatening if undetected.
In seconds after entering the woman’s symptoms into his computer, Pierce made the same diagnosis it took the Florida physicians two years to make--acquired C-1-esterase inhibitor deficiency.
Harris was floored.
“We did OK by this patient thanks to the astuteness of this second-year resident,” Harris said. But if the software had been available two years ago, he said, the diagnosis “wouldn’t have been missed on the first admission or any of the other times.”
Harris and his colleagues now are preparing to run a full-scale study of the PKC system in parts of the Tampa VA hospital, one of the nation’s busiest. If the test is successful, the PKC system could be used throughout the VA’s hospital system.
The PKC system addresses a growing problem: Physicians cannot possibly keep in their heads all the information available about all the conditions known to medicine.
“It’s like giving a hungry man a bushel of wheat,” said Dr. Larry Weed, who founded PKC in 1982. “The problem is getting from a bushel of wheat to a tasty sandwich.”
PKC’s computer system mills the wheat, adds the yeast, takes the bread out of the oven, slices it and lays it on a serving plate.
Patients answer several hundred questions about their medical histories and enter them into a computer. Health-care professionals can enter the results of lab work and physical exams.
The computer searches an ever-expanding database of information culled from medical journals to compare the patient’s condition with the literature. It then offers a possible list of diagnoses or treatments.
Freed from the tedium of taking endless histories and memorizing thousands of symptoms, conditions and diseases, physicians are able to focus on the needs of the patient.
“Our tools enable (physicians) to practice the art of medicine,” said Pierce.
Known in the medical industry as a “decision support system,” PKC’s product and others like it are being heralded as part of the solution to medical mistakes that are thought to kill 44,000 to 98,000 Americans every year.
Such products range from artificial intelligence systems to relatively simple fixes such as computerized prescription writing, which can avert mistakes caused by illegible handwriting.
Decision support systems such as the one developed by PKC promise to play a big role in preventing medical errors, said Dr. John Eisenberg, administrator of the Agency for Healthcare Research and Quality, the federal agency charged with reducing medical mistakes.
“It won’t necessarily avoid the errors being made, but it will stop them before they cause harm,” Eisenberg said.
Computer systems present their own risks, he said. A physician might be tempted to accept what is in the computer instead of doing the proper follow-up with a patient. Computers also can provide too much information.
“It really can slow you down,” he said.
The machine’s best use is to make suggestions, not to replace the physician’s judgment.
“You’d never have surgery based on what the computer said,” Eisenberg said.
Eisenberg said information technology can help physicians in three ways: improving storage and accessibility of patient information, providing quicker access to medical research, and preventing mistakes.
“I think what’s special about PKC is it builds all three, potentially at least, into the same system,” Eisenberg said.
Weed, 76, is no stranger to health-care innovations. Described by Eisenberg as “revolutionary,” Weed changed the practice of medicine in the early 1970s by standardizing the way patient records are kept.
These days, he advocates for changes in how doctors are trained. Rather than forcing students to memorize reams of information that they’ll forget, he said, medical schools should focus on getting students to develop hands-on skills.
“They’re absolutely stuffing these kids with two million answers, then they put them in the emergency room where they can’t match the answers to the problems,” Weed said.
Computerized matchup of symptoms and possible diagnoses is a first step that can be done better by machines than by humans, he said, but it still leaves plenty of room for talented physicians.
“The one thing you can’t do is take out your own prostate. You want people with great hands-on skills. That’s what we have such enormous respect for,” Weed said. “Then you want a marvelous person to work with you, sorting among all the ambiguities.”
PKC employs about 55 people in a renovated mill alongside the Winooski River in Burlington. The company, which also has an office in Washington, has 50 to 60 customers, including the Department of Defense.
Weed and his employees have created 80 separate “couplers” for various medical conditions such as knee pain, headaches or diabetes.
Every day, PKC employees comb the latest medical journals, entering findings from articles into the database.
In Harris’s example in Tampa, when Pierce’s computer suggested the patient’s condition was most likely acquired C-1-esterase inhibitor deficiency, the PKC system cited the latest journal articles on that condition.
The study at the Tampa VA hospital will be run by Dr. Edward Cutolo, who helped physicians there adjust to the computer age by switching to a system in which doctors enter orders directly into the VA computer system.
“The problem with the (PKC) system is the upfront work,” Cutolo said.
But the payoff will come when patients start providing their own histories, he said, eliminating extra work for health-care
