Limitations and Terms of Use
As used here, the term "SOFTWARE" refers to both a program and a database, which together constitute a computerized tool for dealing with medical information. This SOFTWARE has a number of uses, but it is important to realize that it also has real limitations and can produce incorrect results. The purpose of this SOFTWARE is to make clinicians more effective, but it does not replace the clinician and it does not provide advice that can be considered reliable on its own. The SOFTWARE must not be used on "autopilot" - it is meant to supplement the skills of a clinician, not replace them. It is the responsibility of the clinician to make the correct diagnosis, to independently verify the accuracy, currency and completeness of the information provided, and to realize that the SOFTWARE can provide incorrect results.
Uses of the SOFTWARE
This SOFTWARE supplements the skills of a clinician but does not in any sense "replace" the clinician. However, it can add value by:
- Manipulating the information to suggest diagnoses to consider.
- Suggesting additional findings to check, including diagnostic tests.
- Documenting medical information using standardized terms.
- Accessing resources such as references in the literature and patient support groups.
The SOFTWARE is limited to medical professionals
Due to the advanced capabilities of the SOFTWARE and the potential for harm from misuse, the SOFTWARE may be used only by medical professionals who have the training and background to use the knowledge properly- that is by doctors, nurse practitioners, genetic counselors and supervised trainees in these professions. Registered users must not disclose their password to others, even other medical professionals, must guard their password with care and secrecy and must take reasonable precautions to prevent the use of the SOFTWARE by unauthorized persons.
The SOFTWARE should be thought of as a computerized textbook. As with other tools such as textbooks or literature searches, this SOFTWARE cannot replace the judgment, perspective and selectivity of medical professionals.
Limitations of the SOFTWARE
The program and database each have limitations that can result in incorrect results. Many of these limitations are detailed below. Being familiar with the limitations can reduce the likelihood of getting incorrect results. However, it remains the responsibility of the clinician to make the correct diagnosis, and the authors, developers and distributors are not liable for any incorrect conclusions reached using this SOFTWARE or data or any damage, loss or injury that result from incorrect conclusions. Therefore,
(1) THE SOFTWARE IS PROVIDED AS-IS, WITHOUT ANY WARRANTIES OR REPRESENTATIONS, EXPRESS, IMPLIED OR STATUTORY, INCLUDING WITHOUT LIMITATION NO WARRANTIES OF MERCHANTABILITY, OF FITNESS OR AGAINST INFRINGEMENT. In addition,
(2) None of SimulConsult’s directors, employees, contractors, agents, authors, contributors, editors, or other providers or participants shall be liable for damages arising out of or in connection with the use of this SOFTWARE . This is a comprehensive limitation of liability and IN NO CASE SHALL SIMULCONSULT OR ANY PARTY INVOLVED IN CREATING, PRODUCING OR DISTRIBUTING THE SOFTWARE BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES THAT RESULT FROM THE USE OF OR INABILITY TO USE THE SOFTWARE, including, but not limited to, damages due to loss of data, income or profit; claims of third parties; reliance on information obtained from SimulConsult or a linked site; errors, omissions or interruptions; deletion of files or email; defects, viruses, delays in operation or transmission, or any failure of performance; communications failure; and theft, destruction, or unauthorized access to SimulConsult’s records, programs or services.
Incompleteness and inaccuracies
As noted above, the information is not guaranteed to be complete; the databases will have both omissions and inaccuracies. We do not guarantee to have included every diagnosis ever reported in the literature. Also, although the SOFTWARE includes provisions for referencing all information to samples from the literature from the best references, many of the frequencies and incidences in the database are estimated because good information does not exist or we have not yet located it. These limitations are particularly important for databases labeled as alpha or beta versions, since such databases are particularly far from being complete.
Another limitation arises from the fact that each module only contains diagnoses within the particular specialty or sub-specialty that is the subject of the module. Therefore, if your patient has a stroke or brain tumor and you are using a Neurological Syndromes module, the diagnosis is outside the range normally included in the module. Although we will include some diagnoses outside the immediate area of specialty, this will never be done fully and it is the responsibility of the clinician to be the final authority on the diagnostic issues. Furthermore, the borders of a specialty are drawn differently in different regions of the world and the boundaries you use may not correspond to those used by the contributors to any particular module.
We encourage all clinicians who are using this SOFTWARE to submit new information as well as corrections using the database part of the SOFTWARE. Submissions are transmitted automatically over the internet but incorporated into the disseminated database only if approved by editors. The SOFTWARE labels information with the author, editor and reference. By correcting or upgrading information you will help make the database a useful resource for yourself and others and you will be credited with the submission.
Errors of the probabilistic model
Another reason why the SOFTWARE may produce inaccurate results is that the probabilistic model used to rank diseases and findings is only an approximation of reality. This approximation is least accurate when the patient has two or more diagnoses, or when two or more findings convey similar information.
When a patient has two or more diagnoses the SOFTWARE may not find a single disease profile that matches the patient description. Therefore, this SOFTWARE is most useful in situations in which the patient has a single diagnosis. It is the responsibility of the clinician to determine when more complicated circumstances exist.
When two or more findings that convey similar information are specified in the patient description, the program may over-weight the importance of the findings. For example, if a patient is specified as having both macrocephaly and hydrocephalus, this will specify information that overlaps in some ways. Although this issue may be addressed partially in future versions of the SOFTWARE, it will never disappear and it is the responsibility of the clinician to avoid specifying two pieces of information that overlap substantially.
Program or hardware errors
It is possible that our SOFTWARE program may contain errors that result in incorrect output. We work hard to avoid, find and fix such errors, but it is important that users give us prompt feedback on any bugs, errors or issues; please report them by contacting SimulConsult and describing how to reproduce the problem and describing the operating system, browser type and browser version being used. The submission of bug reports is particularly important in cases in which the SOFTWARE appears to give erroneous conclusions.
Another source of error derives from the fact that this SOFTWARE runs on your computer only after being compiled by the "Java Virtual Machine" program used by your browser. The Java Virtual Machine in a browser can differ from one sub-version of the browser to another. Bugs are found quite often within these Java Virtual Machines, and although these bugs typically involve the appearance of various screen elements, it is possible that such bugs could produce output that is confusing or even wrong. Since these bugs will appear the same to the user as bugs in our own program, please report them by contacting SimulConsult and describing how to reproduce the problem and describing the operating system, browser type and browser version being used. We can often change the program to work around the bugs in your browser; indeed the SOFTWARE already includes many such fixes.
It is also possible that errors will occur due to errors in your computer hardware, such as errors in the chips that run your SOFTWARE.
Ownership of the SOFTWARE and database
You acknowledge that SimulConsult owns all copyrights and other intellectual property rights in the SOFTWARE, including the database, and that these are protected internationally by copyright law and treaty provisions. You are authorized to use these only in accordance with the terms and conditions established by SimulConsult (including these Limitations and Uses provisions), which include permission to download, store and print the diagnosis pages generated in response to your inquiries solely to assist you in research, teaching and diagnosing medical conditions in your practice. Thus, you may not use the collection of information in the database to produce your own electronic diagnostic aids or produce your own printed diagnostic aids except for your own use or with permission from SimulConsult. You agree not to reverse engineer, decompile or disassemble any portion of the SOFTWARE program or database or transmit copies of the program or database to others.
Material you submit to the database becomes part of the database and property of SimulConsult, who may use your submissions however it chooses. Authorship credit is tabulated and the details of royalties or other compensation for such submissions will be specified in a separate agreement.
Termination of license
SimulConsult may terminate your right to use the SOFTWARE at any time if it has reason to believe that you are in breach of, or are likely to violate, any of these terms and conditions.
Linked sites
This Web Site contains hyperlinks to Web sites operated by third parties. These links are provided for your convenience and reference only. SimulConsult does not control these sites and is not responsible for their contents. Our inclusion of these links does not imply any association with these sites’ operations or any endorsement or approval of the services, merchandise, materials or contents available from or on these sites.
Copyright Infringement Policy
SimulConsult intends to respond promptly to claims of copyright infringement, and to remove or disable access to infringing material. If you believe that any of the content or materials appearing on this Web Site contain infringing materials, please notify SimulConsult. Your notice should contain the following: a physical or electronic signature of a person (i.e., claimant) authorized to act on behalf of the copyright owner; identification of the copyrighted work claimed to be infringed; identification of the content or material claimed to be infringing; a reference or link to the infringing material or activity, or the subject of the infringing activity, including information to enable us to locate that material or reference; the address, telephone number or email address of the claimant; a statement that the claimant has a good faith belief that use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law; and a statement that the information in the notice is accurate and, under penalty of perjury, that the claimant is authorized to act on behalf of the owner of an exclusive right that is allegedly infringed.
Applicable Terms And Laws
SimulConsult operates its business and Web Site from its headquarters in Massachusetts. Therefore, the laws of Massachusetts, USA, will govern these terms and conditions (as they apply to contracts entered into in Massachusetts by Massachusetts residents); and you expressly agree and submit to the exclusive jurisdiction of the Federal and state courts located in Massachusetts to resolve any disputes related to or arising from your use of the SOFTWARE. SimulConsult reserves the right to make changes to the SOFTWARE and to these disclaimers, terms and conditions at any time by any reasonable form of notice (including posting or emailing notices of change). Your continued use of the SOFTWARE after such notice constitutes acceptance of these modifications.
Summary
This SOFTWARE is intended as a tool to assist clinicians. However, the SOFTWARE has real limitations and can produce incorrect results under certain circumstances. It is the responsibility of the clinician to use this SOFTWARE only to supplement skills, not replace them. The clinician remains the individual with the final authority and full responsibility to make the correct decisions with respect to patients. SimulConsult makes no warranties and assumes no liability for use of the SOFTWARE.