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“For the times when we don’t know the answers”: Stanford debuts digital consult service

Researchers at Stanford have created the ultimate consult, pulling from millions of de-identified patient records to better inform the health of others.

Imagine you're a doctor and a patient comes to you complaining of odd, troubling symptoms, yet lab tests and vital signs are all normal. When asked for a diagnosis, you draw a blank.

Stumped doctors often call upon something known as a "curbside consult," during which they casually run a tricky case by a colleague. Maybe it's an undiagnosed disease, or maybe they're not sure which drug will best help their patient -- either way, the idea is to learn from peers, past patients and old medical records. That's the driving premise behind a new digital consult service at Stanford, pioneered by Nigam Shah, MBBS, PhD, associate professor of medicine and of biomedical data science.

"Our idea was to build something that answers these sorts of questions by sifting through millions of patient records and looking for information relevant to each specific case," said Shah.

And after almost ten years of conceptualization, development and computer programming, Shah and his team have made that idea a reality through something called the Clinical Informatics Consult service, which harnesses a new technology that pulls data from millions of de-identified patient health records.

As I describe in my Stanford Medicine magazine story:

[The] technology -- part mega-search engine, part powerful data analysis -- brings a deluge of data to bear on inquiries too thorny or in the weeds to answer based on established guidelines

... At the core of the service is a one-of-a-kind search engine that scours a trove of anonymized health data. Records of lab test results, prescriptions, written medical histories, vital signs, surgeries and more accumulate by the millions, creating a wealth of information for the search engine to sort through.

Robert Harrington, MD, professor and chair of medicine, and one of the service's founding scientists, describes it as a resource for doctors when they're drawing a blank.

"[It's] not for the times when doctors absolutely know what they should be doing, nor is it for the times when they absolutely know what not to do. It's for the times when we don't know the answers, when a patient population hasn't been studied, or a disease condition has a twist that makes it different from what's been previously reported. And these are often the majority of cases and questions that we see," he said.

So far Shah and his team have fulfilled almost 150 consult requests, helping Stanford physicians determine optimal treatments for their patients, probe new avenues for therapeutics and more.

For now, the service is only open to physicians at Stanford, but the hope is that one day other academic medical institutions can adopt Shah's technology and technique to run the service for themselves.

Image by Harry Campbell

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