BIOSOFT HELP FILES

HOW TO USE CAMEOS PROGRAMS IN CLINICAL PRACTICE

The following notes are applicable to CAMEOS adult and pediatric versions ONLY
1. Programs are available as web applications
2. Programs are available as integrated modules for EMRs
3. Programs can be used live during an average primary care consultation
4. Although the system has nearly 3000 to 4000 symptoms not all of these need probing in a given consultation
5. At a given consultation as in a usual consultation first identify the body system at fault
6. Then collect the relevant presenting symptoms and signs
7. Then run the CAMEOS and first go to the relevant body system in the program symptom panel
8. Then locate a few of the symptoms in the area where the body system located in the system
9. Then probe for the 5 or 6 symptoms up or down that location
10. Then click for the advice
11. Advice can be saved in your phone or if you so wish can be saved in the system also giving password
12. You may then retrieve the data at a later time for follow up

ASSUMPTIONS ABOUT THE USERS AND THE USAGES OF THE CAMEOS
1. CAMEOS is Computer Assisted Medical Evaluation of Symptoms - for PRIMARY CARE and for PRIMARY CARE PHYSICIANS
2. The physician is expected to convert the patients symptom experience into a searchable and specific indicant
3. The users are not expected to be diagnostic experts nor poor diagnosticians - because you need a basic ampunt of medical knowledge and clinical experience in primary care to get the maximum power of the system
4. The system can be used as a diagnostician, documentation expert, reasoning wizard.
5. CAMEOS has 4 major lines of developments - CAMEOS - A for adults, CAMEOS - P for paediatrics, CAMEOS - S for Symptom Checkers, CAMEOS - M for minor usages like diet consultations, developmental screen, vaccines expert and surgery modules etc etc.

USES OF CAMEOS - P FOR PRIMARY CARE PHYSICIANS
(BENEFITS OF CAMEOS - P FOR PRIMARY CARE PHYSICIANS)

1. Generation of most probable diagnosis

2. Generation of a list of differential diagnosis

3. Generation of all the steps taken in making a diagnosis in a given case

4. Reasoning steps for generating the list of differential diagnosis list

5. Mapping of the input symptoms, disease and the management triad of the clinical encounter

6. Autodocumentation of the primary care clinical encounter - the physician has to enter the input symptoms elicited from the patient. The rest is generated by the CAMEOS - P

7. Autocorrection feature for readjustment of the probabilities based on the repeated re-evaluation of the patient for more and refined history taking

8. Autoindexing based on ICD11 of all the common diagnoses made by the system

9. Segregation of the diagnosis from the management. CAMEOS - P does the job of making of the diangosis based on your input. Physician does the managment based on other information gathered during the consultation\

10. Practice of evidence based medicine ensured

11. Availability of the current guidelines on diagnosis of the primary care diseases at the point of care

12. Providing a foundation for continuous professional development

13. Providing a evidence based template for the structured data entry for a clinical encounter

14. Availability of the CAMEOS - P at the point of care where the clinical encounter is taking place

15. Providing a foundation for medical research and audit by way of big data analysis in the future

16. Use of a validated and reliable tool for the differential diagnosis in primary care

17. A unique diagnostic strategy attempting to reduce diagnostic errors - eg dyspepsia
Dyspepsia => functional dyspepsia -> treatment resistent or progressive dyspepsis => UGIE negative dyspepsia
=> Gluten sensitivity, Celiac disease, Wheat allergy
Any symptoms => treatment reractory => progressive => severity high => identification of the boundaries of primary care morbidity
Multiple symptoms => unexplained within the boundaries of primary care morbdidity => Early referral to other specialists so that diangosis is not delayed

18. Moving towards new developments in the health care industry : after visit summary generation, medication reconcilliation, helath care safety issues, digitalization of healthcare, adoption of ICD 11,

19. Moving towards new Healthcare Information Technology (HIT) initiatives - electronic pescribing, Computerized Physician Order Entr (CPOEs)

20. CAMEOS - P solves the problem of missed diagnosis, overdiagnosis and underdiagnosis in primary care (SHOW HOW ?)

21. ECODE (Error Correction Of Diagnostic Evalutions) mechanim built into the CAMEOS-P is the reason for benefit number 20. But ECODE has other benefits as well. Someof these are :
a. Record of detailed diagnostic evaluations carried out by the attending physician
b. Record of diagnostic reasoning behind the attending physician's diagnosis
c. Providing a baseline documentation for the further self audit of diangosis in primary care
d. Providing a baseline prevalence and or incidence of dianognostic problems
e. Providing comparative evidence for the efficiency of clinical practice guidelines - particularly those developed outside of the primary care
f. Providing data for an epidemiology of diagnostic problems in primary care
SEE BELOW FOR EXAMPLES OF
ECODE (Error Correction Of Diagnostic Evalutions)

22. Reduction of unncessary lab investigations based soley on the suggested investigations by the systems :
See the following examples :

Gononcoccal Conjunctivitis
$conjnn = array("D1 - D10 neonate",","days 2-7 after birth usually","In first month of life","eyes red","eyes red bilateral","eye papillae","eye discharge purulent","eye discharge copious","severe injection","chemosis","ph recent maternal gonorrhoea","Discharge Gram stain gramp positive cocci in clsuters","GC culture positive");
"Tx - Ceftriaxone 50mg/kg IM single dose should not exceed 125mg, topical antimicrobials are not recommended. Treat mother and her sexual partner. Insert from guidelines. Dx Ref - https://emedicine.medscape.com/article/1191730-overview, https://emedicine.medscape.com/article/797874-overview",

23. So much of knowledge base required for optimal practice of primary care medicine in integrated into the system - for instance with your good history taking skills some of the most complex clinical evaluations which are possible with the CAMEOS are :

a. Evaluation of a neonate
b. Evaluation of developmental milestones
e. Evaluation of comorbidity by using the statistic of rule out comorbidity
f. Evaluation of complex chronic diseases NCD as well as any other ongoing and recurrent medical problems

THERE ARE MANY WAYS TO USE THE CAMEOS - P

1. You can evaluate the patient using the symptom panel as a Pro Forma. For instance within few
seconds of a medical consultation the system at fault is discerned. Then use the relevant module
in the symptom panel. This is advised when the system is used for educational purposes. This method
may also be used by physicians just entering the speciality of the primary care.

2. You can also evaluate the patient using the principle of neighbouring item approach. Here you will
evaluate the patient and get the key symptom of the presentation. Then go to the symptom panel and select
the key item in the panel. Then probe for the 5 items above and 5 item below. Then either you will get a diagnosis
or you may not. In the latter probe for more key symptoms in the patient's history. Then do the same
as above until you get a dignosis or exclude the common problems

3. An expert in the primary care diagnosis may focus on the symptoms in the symptom panel based on the
principle of descending prevalance ordering. The items in the symptom panel are not in the alphabetical
order. There is a reason for this. If this is the case then selecting fever and then wheeze may need
many clicks or scrolls which is time consuming. Prevalence ordering means that the symptoms which
occur together commonly based on the prevalance of diseases in the primary care are kept close together.
In fact an expert may see the dignostic patterns by visually scanning the symptom panel.

4. There is also an approach referred to as progressive diagnostic refinement by probabilities. Here
the physician runs the program once. Then the output of the program is evaluated for the diagnostic
probabilities. The probabilities given in the output are modifiable as the symptoms reported and symptoms
unreported are given in the output. Then focus on the synmptoms unreported by the patient and focus
and probe deeply for these from the patient. If any found positive and then re-entered the diagnostic
probabilities of the output can be increased and the final diagnosis may change.

5. The knowledge base for the system is based on identifying the common problems in the primary care
first. If there is no diagnosis or elese the diagnostic probabilities reported are very low say below
40% then one may analyse the output for progressive diagnostic refinement by probabilities. If this
also fails the chances are that either index case is a rare disease, uncommon in primary care but common
in other settings like gastroenterology or cardiology or the patient may be normal. To complete the
clinical evaluation then go to the red flag module of the system.

DATA ENTRY RULES
1. Organize your symptoms experience in your mind
2. If you have many symptoms determine the duration of each symptoms. All the symptoms with similar durations comprise 1 illness experience
3. CAMEOS ASC is designed to accommodate single illness experience in 1 run. Each set of multiple symptom sets require a separate run of the program
4. Once you start the progam and is in the home page http://pcdg.info/cameos.php
click the start button. This will bring the symptom panel
5. In the symptom panel symptoms are arranged in major categories - namely
PHELGM SYMPTOMS, BOWEL SYMPTOMS, SINGLE SYMPTOM SYNDROME, GENITAL SYMPTOMS, GYN SYMPTOMS,
JOINT AND MUSCLE SYMPTOMS, EMOTIONAL SYMPTOMS. There are many more catogories of symptom collections
6. You have to select the category of symptoms for which your symptoms belong
7. Then you can focus your attention only to the items in that category
8. If you have many symptoms for which most of the consultants have expressed the opinion that nothing wrong can be found then you can focus on the emotional symptom section
9. SINGLE SYMPTOM SYNDROME is for evaluation of chest pain, backache and abdominal pain when they are not accompanied by any other symptom referrable to the system concerned
10. To select a symptom click on the symptom
11. To select many symptoms press 'ctrl' button in your key pad and click with mouse each symptom
12. To deselect press 'ctrl' and click a selected symptom then it is deselected
13. Once you are stisfied you have correctly entered the symptoms of you illness experience then click advice button
14. The program will run without any other data
15. But if you want to have a copy of your consultation then enter the data in the text fields and run the
program as usual. Click 'advice' to get the output. Them click 'record button to 'save' data