Recently, one of the folks in our office dropped their car off for an MOT. Naturally, without ‘diagnosing’ the car in the first place, the mechanic would never have been able to conclude what was wrong with the car, and how best to fix it. The concept of diagnosis is not one that is difficult to understand, and naturally, the results of a diagnosis dictate the subsequent action that will follow; there is no sense in doing a liver transplant when a kidney is the issue.
However, determining the right diagnosis can often present a challenge, which is why, regrettably, we so frequently hear of patients who have been given the wrong diagnosis and have subsequently received treatment that did nothing – or worse. With current diagnosis methods, this is an unfortunate side effect of our bodies only having a limited set of responses. A headache can be just a headache, but in rare cases it can mean something much more serious. A number of different projects we’ve been working on have suggested how improved data capture can lead to more accurate diagnoses.
Where we fit in
The form a diagnosis can take will of course vary. It may be an informal discussion, a simple paper questionnaire or even an MRI scan. What each of these processes has in common is that information must be collected, stored, sorted and analysed in order to hint at a potential cause. The more complex the illness, the greater the chance for a diagnosis error; often, the treatment of debilitating illnesses is greatly improved by an earlier diagnosis.
Let’s take the example of dementia, which has been much talked about recently thanks to the launches of the National Dementia Strategy and the PM’s Dementia Challenge. One of the major challenges in dementia is to improve diagnosis and detection, particularly for those over the age of 75, some of whom may not be showing any early warning signs.
At the recent Health Plus Care event, Wendy Burn, Dean of Royal College of Psychiatrists, spoke of a number of key issues in relation to dementia diagnosis. Currently the standard diagnosis tool is the Mini Mental State Examination (MMSE), which tests a patient’s memory and general knowledge. Points are scored out of 30, with a low number of points indicating that a patient is more likely to have dementia and hinting at its severity. One of the main flaws Wendy Burn cited in this test is that by simply using a points system, a unique individual’s circumstances are not taken into consideration. For example, a highly intelligent professor may have dementia, but still score high marks on the test. For this reason, other factors need to be taken into consideration, such as the ability to carry out daily tasks and unusual behaviours (forgetting something, that the person would normally not forgot, regularly).
Where do we fit into this? Considering that a diagnosis of Dementia depends on the individual and not just their memory – particularly as some people may naturally have poor memory – it is important to profile each person diagnosed.
Potential improvements to dementia diagnoses
A possible solution we propose is a dashboard system, which would contain demographics of an individual as well his/her medical history, ability to carry out daily activities and points achieved on the MMSE test. The dashboard groups these data sets together and provides an overview of the patient in question; in addition, the dashboard can correlate between these four criteria in order to aid decision-making. For example, if a person’s medical history shows a period of substance abuse, this can be a factor of memory loss, suggesting that dementia may be the right diagnosis. With such a system, the patient’s doctor would then be able to set specific criteria based on his/her own expertise in order to determine whether a dementia diagnosis is possible at that stage, or whether further tests may be required.
With all the necessary information in one interface, GPs would be able to conduct a range of different analytics all under one space, with information readily available as needed. This would enable them to make a diagnosis faster, but more importantly, with increased confidence that it would be the right diagnosis. Additionally, such a system may be able to provide warnings based around a medical history in order to facilitate prevention. For example, if a person’s history shows he/she is a heavy smoker, their GP would be able to give visual feedback that highlighted the links between smoking and dementia, thereby allowing patients to make informed decision around their healthcare needs.
In essence, such a system could radically improve the process of diagnosis, empowering both doctors and patients to make informed and more accurate decisions based on individual needs. If you’d like to hear more about such a system or introduce it to your own care provision, please get in touch.