Robertson Research Institute: Software Gives Doctors a Virtual Second Opinion

In a developing nation, a physician enters his observations of a patient's condition into a tablet computer. A user-friendly application compares the data to a massive knowledge base, then requests additional information from the physician to facilitate a rapid and accurate diagnosis through a unique "virtual dialogue."

That's the goal of the NxOpinion project at Robertson Research Institute, which is testing an innovative approach to medical informatics that's aimed at physicians in underserved communities.

According to Dr. Joel Robertson, founder and CEO of Saginaw, Mich.-based RRI, the organization has been working on NxOpinion (pronounced "next opinion") since 1992, when he decided to provide physicians with "exception-based, rapid diagnostics, for when a person fits the textbook case but doesn't get better."

The decision-support system required the building of interfaces for busy physicians and the development of content management systems for the huge amount of data that users would access and add to, Robertson explains.

"The problem with most [diagnostic support] products is that physicians are impatient and in a hurry -- they don't like spending time on re-entry of data," says Barry Heib, a medical doctor and an analyst at Gartner Inc.

"Other databases require doctors to have a medical informatics background. We want NxOpinion to be usable by any physician," says Robertson.

"The output must be equally user-friendly as the input," he says, adding that NxOpinion is a mobile technology that could eventually "reside on a PDA, tablet computer or PC and be updated when those devices are synced."

Physicians in the Dominican Republic use a tablet PC to test the user interface of NxOpinion.
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Physicians in the Dominican Republic use a tablet PC to test the user interface of NxOpinion.

Image Credit: Robertson Research Institute

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"Evidence-based medicine is especially important in helping physicians [in developing nations] make a diagnosis when they may have only one chance to refer a patient to a specialist," says Dr. Mark Bates, medical director of the NxOpinion project.

NxOpinion "was designed to facilitate and enhance workflow," says Bates, who participated in pilot testing in the Dominican Republic. "I didn't think any of the doctors there had seen a tablet [PC] before, but they easily picked it up. Adding data worked better than expected, thanks to the flexibility of the English/Spanish translation capability."

RRI contracted with Sagestone Consulting Inc. to develop NxOpinion. The Grand Rapids, Mich.-based company built the application with Microsoft Corp. technologies.

"The core of the application engine takes data, correlates it and produces differential diagnoses," says Keith Brophy, CEO of Sagestone and chief technology officer of NxOpinion at RRI, referring to the Bayesian logic used by the system. "It's a unique way of leveraging decision theory.

"We wanted dynamic updating of data. As evidence is entered, the diagnostic options presented change," says Brophy. "We needed a fast turnaround of four clicks or less, because our testing found that if it took three minutes or more, a diagnosis would be abandoned."

NxOpinion faces several challenges, including keeping data current, interfacing with existing systems and obtaining user feedback, notes Heib.

Maintaining database integrity has required "rigorous validation," Bates says. Data collected in the field could lead to the ability to track the prevalence of diseases in different regions, he adds.

Another goal of the NxOpinion project is to help reduce medical errors, which are often the result of bad processes rather than ineptitude, says Bates.

Testing will continue in the U.S., the Dominican Republic, Africa and Australia through this year and next; RRI plans to release NxOpinion in 2005.

Robertson is also eyeing possible long-term goals for NxOpinion, such as incorporating multilingual and culture-specific interfaces, using it as an educational tool and eventually expanding from urgent care to chronic and preventive care.

RRI's nonprofit status has helped it gain cooperation from patient-care organizations worldwide, since its mission is to help save lives rather than compete for business.

"It's an unusual approach," says Heib. "What they're trying to do is certainly noble and laudable, and they'll hopefully be able to add value to health care in underserved communities."

"We're trying to revolutionize medicine, not get rich," Robertson says.

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