Devices & Technology

On-screen Disease Diagnoses

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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 medication list?

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 universities.

“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.

Clinical Scenarios

“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.

Patient Benefits

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 refer.”

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.

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