Enhancing clinical sense in rare disease diagnosis: a cloud computing collaboration approach using google workspace

Rare diseases is a growing global public health priority. Due to their rarity, these diseases frequently go misdiagnosed or go unnoticed, which has a serious negative influence on patients’ and families’ physical and mental health. Currently used methods for enhancing diagnosis include using electronic medical records, conducting longitudinal studies, and compiling data from across the country. But in our opinion, a clinician’s clinical sense is ultimately what determines an accurate diagnosis. The authors discuss the challenges in diagnosing rare diseases and propose a novel strategy to improve clinicians’ clinical sense using cloud computing such as Google Workspace, a free platform that can serve as a noticeboard and especially helpful in developing nations with limited resources. Cloud computing enables real-time reporting, making diseases accessible to a large number of clinicians. As a result, clinicians can gain invaluable experiences and familiarity with rare diseases, which can improve their diagnostic skills in identifying future patients with rare diseases.


Background
Rare diseases (RD) is an emerging global public health priority [1] .Currently there are ~7000 RDs documented in the literature, of which 80% have genetic origins [2] .On average, it takes a patient 7.3 doctor visits and 4.8 years to receive a correct diagnosis.Some never get one, and many wait for decades [3] .Similar to other illnesses, RD can significantly affect a patient's and their family's physical and mental health [4] .Because RDs are not as common, medical professionals tend to pay less attention to them, which frequently results in "misdiagnosis" that can cause serious morbidity [3] .Moreover, patients may incur higher medical costs as a result of prolonged and occasionally unnecessary investigations [4] .Furthermore, a lot of RDs are chronic, which lowers the patients' quality of life even more.Numerous RDs include mental retardation, behavioral abnormalities, and psychiatric illnesses that are distressing for both the patients and the caregivers [5] .

Possible strategies to avoid 'misdiagnosis'
The major challenge faced by clinicians with RDs is their symptoms, which can have multiple interpretations and are frequently uncommon [3] .The three most common types of diagnostic errors are (1) context errors, which occur when the diagnostic possibilities for a disease are too restrictive, (2) availability errors, which occur when a more common or more familiar diagnosis is preferred, and (3) premature closure, which occurs when alternative options are abandoned after a likely diagnosis is made [3,6] .Various strategies have been employed to tackle these diagnostic challenges.One strategy to address the challenge posed by their rarity is the gathering of nationwide data on the prevalence and incidence of rare diseases as well as the conducting of longitudinal studies to determine natural history [7] .To aid in the diagnosis of rare diseases, some authors have investigated the use of electronic medical records (EMR) to analyze phenotypic data about the patients [6] .We believe that, a clinician's "clinical sense" is ultimately what determines an accurate diagnosis, with all other strategies just serving as a supporting tool.

The clinical sense
The three processes of observing, recording, and thinking form the tripod that underpins the entire framework of clinical medicine and are the foundation of clinical knowledge [8] .The process of clinical diagnosis is multistage and primarily involves two approaches: (1) intuitive and (2) analytical.The foundation of the intuitive approach is the so-called tacit knowledge that results from a multitude of experiences enhanced by difficult-to-transfer personal perceptions and beliefs.The analytical method is predicated on explicit knowledge that is derived from established, widely accepted facts, regulations, and procedures that have been recorded in written or electronic form [9] .Increasing clinical exposure to RDs is essential for developing the clinical sense, especially intuitiveness, as it provides stimuli to enhance perception.The issue with it, though, is that because RDs are inherently rare, clinicians might not have enough opportunities to interact with them in their work to gain a clinical sense.Although many institutions have easily accessible disease databases, these do not always enhance the perceptional experience to foster the development of a proper "clinical sense."We believe that the development of clinical skills is contingent upon the observance of time-honored bedside manners, as noted by Sir William Osler, the father of modern medicine, who famously remarked, "To study the phenomena of disease without books is to sail an uncharted sea, while to study without patients is not to go to sea at all." [10] Cloud computing collaboration as a novel strategy We have extensively used information technology in an 'analytical approach' to RDs.In this manuscript, we look at a simple but effective use of cloud computing to develop our 'intuitive approach' in order to develop clinical sense.Clinicians could use such a cloud computing platform to report, update, and track the RDs they encounter at the bedside in real-time, which could then be communicated to a closed group within an institution or hospital.For educational purposes, medical residents and students may also be granted access.This creates a collaborative setting where numerous clinicians can collectively gain invaluable experiences and familiarity with rare diseases, which can improve their diagnostic skills in identifying future patients with RD.Therefore, they can now come into contact with diseases that they might have only rarely encountered in their lifetime or could have easily overlooked.

Google Workspace as a platform
In developing nations, there is a paucity of epidemiological data on RDs [1] .This could be the result of underdiagnoses brought on by a lack of diagnostic resources.Paid software is also not feasible in environments with limited resources.Therefore, freely available to everyone Google Workspace is one possible solution.Formerly known as G Suite, Google rebranded it as a comprehensive, cloudbased suite of productivity and collaboration tools in 2020.It includes user-friendly integrated online applications such as Docs and Sheets that can be utilized for the aforementioned objectives in a real-time communication platform or noticeboard.

Ethical issues
Involvement in medical education is voluntary for patients, and their involvement remains an act of altruism.Our profession bears the moral responsibility of treating patients, and the difficulty is in providing education without endangering patients' safety or rights [10] .Patient data should only be shared on these online cloud computing platforms with appropriate consent, and concerns about data security should be appropriately handled.

Conclusions
Clinicians can use a readily available cloud computing online platform, such as Google Workspace, as a noticeboard to improve their clinical sense by collectively gaining invaluable experiences and familiarity with rare diseases, which will enhance their clinical diagnostic ability to identify future patients with rare diseases.