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How the Digital Clinician© works


Here is how the Digital Clinician® works.  If clinicians judge that they have either an emergency case or mass casualty surge, they select the Red Zone for Clinical Decision Support.  After they do the ABCDE’s of Triage, they protect the clinical field and themselves personally from both patient violence and contagiousness.   When they judge Emergency to be cleared, they adjust their clinical state of awareness to match the Orange Zone by following the evidence based rules of Triage embedded in The Digital Clinician®.  They are thus informed to approach the patient cautiously to rule in injuries and illnesses based on “Likelihood” with each presentation; knowing the mechanism of injury, for example, informs them what to rule in. 

When all Very Urgent illnesses and injuries have been adequately treated or stabilized, the The Digital Clinician® supports the clinician for a more thorough history and examination.  By following the seamless rules of the Yellow Zone of The Digital Clinician®, illnesses and injuries whose severity does not require definitive intervention within The Golden Hour can be ruled out – i.e.  Ankle Fracture. 

Later zones that match the clinician’s judgment of severity and likelihood support Triage to Acute Care.  The Green Zone of The Digital Clinician® supports a more relaxed and through examination to rule out illnesses and injuries requiring definitive intervention within the first two hours of onset or injury.   Patients ruled out in clinical states of awareness matching the evidence based rules and knowledge base in the Green Zone are determined safe to diagnose and treat within four hours; they are usually determined to suffer from a chronic illness that does not require either Urgent or Acute Care – i.e. Tension Headache.   The Blue Zone of the Digital Clinician® supports initiation of definitive workup of chronic illnesses or re-injuries by use of visual graphics. 

An important feature of Artificial Intelligence embedded in The Digital Clinician® is the Reassess Button.  This function both recognizes and supports every clinician’s need to change his mind and clinical state of awareness when a patient either sours or, conversely, improves.

In the Post 9/11 world of threatened terrorism and seemingly worse acts of Mother Nature, International Law mandates effective Triage that is blind to social class, race or ethnicity.  Nonetheless, First Responders who show up on the scene of multi casualty incidents are oftentimes untrained – i.e. policemen – or inadequately trained – i.e. paramedics encountering patients far from a functional Trauma Center.   Recurrent training can both teach First Responders the rules and knowledge base that they need for their expected clinical roles.   And, using simulation with E-patients can improve their test scores by 20%.  Likewise, supporting them in their prehospital care by means of Telehealth - without even the inclusion of clinical decision support from an expert system - reduces mortality and mobidity by 25%.   Finally, it has been demonstrated that utilization of expert systems like The Digital Clinician® for Interview Support of Diagnostic Workup in Acute Care reduces face-to-face time with patients by one hour per day.  Further savings are realized in the reduction of dictation costs for documentation by over $1000 per month and risk management, while reimbursement improves.