After 30 years in other forms, in 2005, NERVLINE became a web based application (online.nervline.net) leaving behind standalone PC, Palm Pilot and Windows Mobile handhelds. It allowed us to experience how you used the product and lead us to new developments.
The NERVLINE concept was cross referencing symptoms across citations leading to a differential diagnosis by scanning the titles and considering the diseases suggested. What we learned was that physicians searched by disease, not by symptom. This was confusing at first as it seems more natural to find a solution by searching on a problem. But in truth, there was no resource readily available that equated to an index of diseases by symptom. The industry had adapted by creating a pattern where a typical physician would hypothesize and then research to validate. This left a gap for rare diseases or unusual manifestations of typical diseases plus other limitations on the scope of an individual’s medical knowledge.
It was then that we realized that within we did have an index of diseases listed by symptom and created NeurologicDX.com which focused on creating a differential diagnosis using input from one or more symptoms. We have had great success in training residents to understand and use the system but without the explanation it seems difficult for many users to understand how to use it or comprehend and apply the output.
We attempted to compare the results of a checklist based differential diagnosis system (represented as NeurologicDX.com) by devising a simple casual study. We asked a number of practicing Neurologists to list as many diseases as they could for each of three symptoms. The results were compared to the list created for that symptom by NeurologicDX.com and showed that the physicians improved their options by an average of 65% when aided by the machine. (See “Checklist Improves Diagnosis over Physician Recall” poster presentation #P1.319 at the 2014 AAN meeting in Philadelphia)
The observations of user interaction with NeurologicDx.com combined with the results of the study lead to another iteration called NeurologyIndex.com. The user input was reduced to singular terms with cross referenced pairs that when clicked provide relevant citations and links to further information. This site represents an exhaustive list of neurologic diseases by symptom and related terms for given diseases, creating the most substantial index in the field.
These products are presented without cost or advertising and are offered as models for the health field in advancing the use of technology. To be clear these are tools for practicing physicians and not a “do it yourself” diagnosis system. They require experience, understanding of the terms and knowledge of an individual case to intelligently select the input and process the resulting list in a meaningful way — not as a replacement for the physician.