The information technology revolution and the holistic medical movement have much in common: both are based on the ideal of individual empowerment through broad dissemination of information and free exchange of ideas. Both have a firm root in general systems theory, and share a vision of improving inter-system function by improving communication.

Over the last few years, a number of tools have emerged to address the specific informatics needs of holistic medical practitioners. From practice-building networks like Starfish Health Partners and myNDonline, to management tools like eNatro, reference databases like Natural Standard and the newly expanded Napralert, to clinical guidance systems like iCaduceus and SaluGenesis, these new IT developments can greatly empower natural medicine practitioners.

This is the first article in a series of profiles of leading IT systems for holistic physicians. In this issue, we explore iCaduceus: The Clinician’s Alternative, a community-based diagnostic and treatment guidance tool that can help bridge the gap between conventional allopathic diagnoses and naturopathic, non-pharmacologic therapeutic options.

Peer-Based Clinical Guidance

The iCaduceus project began life as a study aid compiled by overwhelmed naturopathic medical students at the National College of Naturopathic Medicine. Gil Winkelman, and his wife Christie, then in the midst of their grueling second year, were simply trying to find a way to systematically organize and conceptualize the vast body of clinical information they were trying to master.

“When our classmates and professors saw it, they immediately saw value in the idea and encouraged us to develop it further. We then decided to add treatment information, including botanical medicine, clinical nutrition, homeopathy, vitamin/mineral supplementation, and hydrotherapy. It occurred to Gil that he could create something much more user-friendly and elegant than other diagnostic tools on the market. Other programs had elements of what we were doing, but no other products had this special blend of components designed especially for the holistically-minded physician.”

iCaduceus evolved into a differential diagnosis and therapeutic guidance tool now in its field-testing phase. The system, available online and on a handheld platform, provides both naturopathic doctors and conventionally-trained physicians with a framework for comprehensive holistic evaluation, diagnostic workup, and selection of natural non-pharmaceutical therapeutics. In short, it tries to systematize holistic medical thinking and help clinicians make good sense of the myriad therapeutic options.

In creating a functional, user-friendly database, Gil drew on 10 years of experience as a computer programmer. Prior to enrolling at NCNM, Mr. Winkelman designed software that regulates how energy is traded between the states of California and Oregon on an hour-by-hour basis, based on thousands of complex mathematical formulas.

A Collaborative Clinical Community

The Winkelmans’ initial effort quickly became a hub for community information sharing within NCNM’s clinical orbit. “In August last year, after our first set of board exams, I realized this project was just too large in scope—at almost 400 conditions—for Gil and me to complete on our own,” said Ms. Winkelman. “I recruited 20 other tired yet enthusiastic students to complete the diagnostic info and start adding treatments that they had already learned in classes. We all researched tons of conventional diagnostic and naturopathic treatment texts.”

Gradually, faculty members, including Dr. Dick Thom, came forward to offer expertise and experience. Several other practicing NDs offered the iCaduceus group all of their treatment notes, gathered over 30-year careers. The main development phase involved a team of about 10 physicians, mostly NCNM faculty but also several MDs, who reviewed all information related to conditions in their areas of expertise. In many ways, the project represents a model for collaboration and interdisciplinary goodwill all-too-rare in medicine today.

The web-based version, which serves as the “mothership” for the project, can be used in many different ways. First, it helps in pre-visit preparation by framing good clinical questions based on chief complaints. “In this way, it’s a sort of a history-taking system,” Christie Winkelman told Holistic Primary Care. “NPR aired a recent study that showed that most doctors do not ask all of the correct questions and often end up missing the diagnosis as a result.” The web-based tool can also be used to research cases, and for in-visit consultation. A preventive lab calculation feature allows clinicians to enter patient age, gender, and lab values for key diagnostic panels, and produces a list of differentials based on optimal reference values.

Recognizing the clinical community’s love of handheld devices, the iCaduceus team has made the system available on PDA devices. An offline PDA version, which runs on any device that can run the iSilo program, has the full iCad database, but not the search or the lab calculation capabilities. A third version, for iPods, contains the treatments database only.

Pocket PC and Palm versions, as well as the regular PC version, are available with the 7-day immediate free trial available at www.icaduceus.com. Anyone can sign up for this and get a login and password for full access of the product including all content and search features.

Whole Systems Thinking

One of the main virtues of iCaduceus is that it incorporates holistic and naturopathic whole systems thinking into its differential diagnosis model, leading clinicians to consider underlying causes for a given symptom that might not be readily obvious. For example, if one follows the data thread for “anxiety,” it will lead to, among other things, a consideration of digestive disorders including leaky gut syndrome, irritable bowel or celiac disease. Patients with these conditions often do have anxiety, but if that is the chief complaint, conventional medical thinking would tend to keep the focus on the anxiety and other psychosocial issues, thus missing the deeper systemic imbalances.

iCaduceus is a constant work-in-progress; the system is designed to evolve in accord with the natural medicine knowledge base and the needs and experiences of its physician user-community. It is as much about community-building and collegial exchange of experience as it is about guiding individual practitioners in their day-to-day practice.

“Our paradigm is very much about cooperation, not competition. We want to provide frameworks to begin thinking about health not in terms of an absence of symptoms but in terms of optimal physiology. There is so much to learn, and we must all get out of our corners, so to speak, and work together toward what is really our common goal. It is only then that we have a chance of making this world a healthier place where we can both truly decrease the incidence of chronic disease, and help people to get the most out of their lives.”

Experience-Based Medicine

Though iCaduceus is well-founded on scientific ground, its designers have not limited themselves to the constraints of double-blind randomized controlled trials. While this may make “evidence-based medicine” advocates nervous, the Winkelmans believe their system, which encourages clinicians to share observational data and clinical experience, will lead to a more useful system and better patient care.

“The reality is, even in conventional medicine, the research does not often give the answers many physicians seek because of flawed study designs, experimental groups that are too small or too exclusive, non-compliance of subjects, and other variables,” said Ms. Winkelman. “In addition, many drugs are used clinically for purposes other than those for which the FDA approved them. Exclusive reliance on RCTs provides a false sense of security, as we saw with Vioxx.”

That said, many of the herbal and nutritional treatments in the iCaduceus database have been shown effective in clinical trials. But the system also incorporates the clinical judgment and empirical knowledge of the clinical community from which it developed.

“We don’t want to put a limitation on treatments that may benefit the patient. Most of the treatments in our database are inexpensive and fall under the most extreme interpretation of the ‘Do no harm’ edict, meaning that they produce few adverse effects,” said Ms. Winkelman.

As iCaduceus continues to evolve, the system will incorporate practice management components as well as clinical information. “We want to really help physicians who want to use alternative medicine, not only clinically, but business-wise as well. Most of the software out there isn’t providing the type of system frameworks to allow for practice management to be done both well and affordably on the smaller scale we see in outpatient settings.”

The next iCad module will include an electronic medical record and scheduling framework. “This is sort of a selfish goal of mine because I want to have a system in place for when I go into practice,” said Ms. Winkelman.

Physicians can access iCaduceus: The Clinician’s Alternative, including the PDA-based applications, for a yearly subscription fee of $399. The company is offering a free 7-day trial. Visit www.icaduceus.com or call 888-256-8579 for more information.