By Suzi Birz, principal, HiQ Analytics, LLC
Have you ever found yourself rushing around the emergency
department looking for an atlas of rash photos to help with a differential
diagnosis? Have you found the book only to then spend precious minutes flipping
through pages? What if the photos were catalogued on a computer and you could
find the photo by entering the characteristics of the rash or the patient’s
VisualDx Clinical Decision Support Software, manufactured by
Logical Images of Rochester, New York, contains information and nearly 13,000
high-quality, detailed images related to more than 700 diseases. All diseases
have text for point of care information, including diagnosis synopsis, what to
look for, best tests, differential, management and therapy. The information
represents 10 years of research from more than 60 physician editors and three
“Imagine you are seeing someone with a visually diagnosable
problem and you wish you had an expert nearby, but that expert is not
available,” explained Art Papier, MD, Logical Images’ chief scientific officer
and associate professor of dermatology at the University of Rochester, in
Rochester, New York.
Unlike paper atlases, this tool provides many ways to drill
down until you get a visual that matches what you are seeing and the text
confirms the symptoms and the treatment.
“Early detection of life-threatening conditions is one
quality-of-care improvement brought by VisualDx,” Papier noted.
“Quality-of-care issues include the diagnosis of rashes caused
by medications, or considering an infectious disease in an HIV patient,” said
Papier, who provided two clinical situational examples:
A nurse in the emergency department is triaging an HIV patient
with a fever and a rash. VisualDx allows the nurse to enter these
characteristics and see a spread of photographs of a patient with these
symptoms. If there are other symptoms, perhaps an ulcer on the leg, the symptom
can be added and the photo array will be rearranged to bring the closest image
match to the top of the deck.
In another example, a nurse wants to know if a drug can cause
a rash and what kind of rash it would be. VisualDx allows the nurse to enter the
medication and immediately see the different reaction patterns and diseases
possibly induced by the medication. The photo array and text information allow
the user to see specific patterns rather than simplifying and calling each
medication reaction a “drug rash.”
“There are several serious medication reactions that must be
differentiated from more common reactions,” Papier explained.
Public Health and Terrorism
VisualDx has been approved by the Centers for Disease Control
and Prevention (CDC) and the Health Resources and Services Administration (HRSA)
as a public health tool for terrorism preparedness.
“For instance, the visual effects of anthrax exposure can be
rapidly verified by this software, ensuring that early diagnosis is made and the
patient is not sent home,” Papier described. “The same would be true for
smallpox and other public health threats.”
The flip side of preparedness is addressing the false
positives inherent in trying to have prepared physicians.
“The bioterrorism diagnoses are rare by definition, the ‘false
positives’ are not,” Papier said.
The system can help ensure that emergency departments are not
quarantined when no actual threat exists.
VisualDx allows busy practitioners to check differential
diagnoses. L. Gordon Moore, MD, a family medicine physician in Rochester, New
York, uses VisualDx in his practice. Moore has computers in his exam rooms and
finds that he uses the software in three ways.
“I hone symptoms down quickly to a likely diagnosis; I use it
with patients for reassurance and I used it to confirm the treatment even when I
make the diagnosis without the tool,” Moore explained.
“The patient response has been ‘cool,’ and you cannot
underestimate the power that the visual has when the patient can see a photo
that looks just like what she or he has,” he added.
Moore extolled the virtues of the search capabilities.
“You can enter characteristics such as ‘itchy, red, flakey’
and a photo array will be presented, even without the dermatological terms,” he
said, adding that thanks to the software, “I know when to reassure and when to
What’s In, What’s Next
Since VisualDx was first released in 2001, features continue
to be added. It currently includes dermatology, radiology and oral medicine.
VisualDx has images of conditions on dark-skinned patients as well, filling an
underserved knowledge base. It is in use in more than 400 emergency rooms and a
number of residency programs and medical schools.
If desired, hospitals can add links to hospital-based
procedures for the staff to follow in the event of a specific diagnosis.
Next up, Logical Images will be adding elder care, fingertip
and nail, external eye diseases and child abuse.
Technical and Purchase Information
VisualDx runs on any PC connected to the Internet with Java.
It can also run stand-alone with the software loaded on the PC. Appropriate
security is built in to ensure that authorized users are using the system.
With respect to training, Moore explained, “Getting started
using VisualDx takes only a few minutes of training, but learning how and when
to best use it comes with experience and time.”
For more information, visit the Web site of Logical Images.
Nursing students can purchase a one-year subscription to
VisualDx for $99 for the Pediatric, Internal Medicine and Family Practice
packages, and $149 for the Infectious Diseases package.
© 2006. AMN Healthcare, Inc. All Rights Reserved.