Symptom checkers demonstrate increasing accuracy

These days, it's become common for health care consumers to research symptoms online before consulting a doctor.

In fact, 35 percent of American adults say they use the internet to self-diagnose or to help someone else self-diagnose. This trend in online health research has prompted analysis into the accuracy of symptom checkers, and the results are promising.

One notable study was conducted by a team of researchers at Harvard Medical School, led by Hannah Semigran. The study, "Evaluating symptom checkers for self diagnosis and triage," published in the July 2015 issue of the British Medical Journal (BMJ), was designed to determine the diagnostic and triage accuracy of symptom checkers.

Promising results for a rapidly growing technology
This 2015 BMJ study tested 23 symptom checkers that provide health information across a range of conditions using 45 patient scenarios (not actual patients), equally divided between emergency patients (emergency care required), non-emergency patients, and self-care patients. Patient scenarios were used instead of real patient interactions because each scenario had a specific, diagnosable condition to which it was linked. With real patients, a diagnosis may take more time or involve factors that are difficult to control in an experimental setting. Main outcomes measured included whether the correct diagnosis was listed in the Top 20 possible diagnoses.

According to the study, the symptom checkers performed as follows:
• The correct diagnosis was listed as the first option in 34 percent of patient interactions,
• The correct diagnosis was listed in the top three options in 51 percent of cases, and
• The correct diagnosis was listed within the top 20 diagnoses in 58 percent of cases.

Since the publication of this study, technology has evolved and new platforms, such as Health Navigator, have emerged. Health Navigator is a documentation-support and diagnosis-triage, symptom-checking platform that can be used by health care systems, medical call centers, insurers, e-Health and telemedicine companies to streamline workflow and the patient experience by improving the intake and screening process.

In a recent follow-up analysis, the lead author of the original BMJ article tested the Health Navigator platform using the same study guidelines. Results from the analysis showed that the Health Navigator symptom checker was more accurate than all other symptom checkers in the original study.
For example, when compared to the results of the original study, the Health Navigator symptom checker outperformed other symptom checkers for emergency, non-emergency and self-care scenarios. More specifically, Health Navigator:
• Listed the correct diagnosis first in 56 percent of patient interactions (vs. 34 percent for all other symptom checkers).
• Listed the correct diagnosis in the top three possible causes in 78 percent of cases (vs. 51 percent).
• Listed the correct diagnosis within the top 20 possible causes in 96 percent of interactions (vs. 58 percent).

Semigran, the study author, also commented on Health Navigator's strong performance and accuracy, particularly on the more complicated and serious vignettes.

It is important that diagnostic technology and symptom checkers continue to evolve and advance, as these solutions are playing an increasingly important role in care delivery and patient satisfaction. Symptom checkers can be tools for consumer engagement and health information education. They can also provide decision-support and improve efficiency for health care organizations and clinicians.

By keeping our eyes on the prize of improved diagnostics, the e-Health and telehealth industries have the opportunity to contribute to improved outcomes for patients and reduced costs for health care organizations.

About the author:
David Thompson, MD, CHC, FACEP is CEO and chief medical officer at Health Navigator. A part-time faculty attending in the Northwestern Memorial Hospital Emergency Department, Dr. Thompson also serves as chief medical information officer for Schumacher Clinical Partners, and works as an author and partner with Self Care Decision, LLC and Schmitt-Thompson Clinical Content, LLC. In a collaboration with well-known pediatrician Dr. Barton Schmitt, Dr. Thompson has developed a comprehensive set of telephone triage protocols that are used in medical call centers and doctors' offices in the United States and internationally. He is board-certified in both internal medicine and emergency medicine, having completed a dual residency at Northwestern Memorial Hospital at Northwestern University. Dr. Thompson is certified in health care compliance and is a Fellow in the American College of Emergency Physicians. He can be reached at

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