We had the chance to take a look at the VisualDx mobile app, the mobile version of VisualDx Health, a website that helps in clinical decision making of dermatologic, infectious, genetic, metabolic, nutritional and occupational diseases, benign and malignant growths, drug-induced conditions, and other injuries.
The app is available for iOS in the iTunes Store and through Google Play for Android devices. It features a trial period of 15 days, but requires a license after it’s over. This will cost you between $99.99 and $299.99 for one year, depending on which content you want access to. However, a cheaper license is available for institutions. The minimum requirement to run the app is iOS version 4.3 or Android version 1.6.
The interface is simple and user friendly, and similar across Android and iOS. On the home screen of the app you can either choose to look up a diagnosis, or build a differential based on the signs and symptoms of a patient. In the differential builder you can choose the clinical scenario using the location of the finding, the lesion type, key findings and other findings. Based on this information, VisualDx shows you images of the possible diagnoses, in order of correspondence with the findings.
Disease descriptions feature a clinical summary, with chapter headings like “Synopsis”, “Look for”, “Diagnostic Pearls” and “Therapy.” References can be found below the disease descriptions and a gallery of images of the disease is displayed on top. The images can be viewed individually and enlarged.
VisualDx is a very good decision support tool, especially for dermatological conditions or skin manifestations of systemic disease. The app is intuitive and the interface is easy. The differential builder is a great feature, as well as the large amount of images in the VisualDx database. The clinical summaries are concise, which is good if you want a brief summary, but has shortcomings if you want full information on a disease. The app also requires a data connection to function, which can be a drawback for some of us. Overall, VisualDx is a great app for clinicians to support in their clinical decision making, especially for dermatologic conditions and external manifestations of disease.
In addition to this brief summary of VisualDx’s mobile app, we also asked Noah Craft, Chief Medical Officer at VisualDx, to tell us a little more about VisualDx.
Stanley Darma, Medgadget: The visual aspect is very important for clinical decision making. Can you tell us how the idea of VisualDx came about and for whom it is intended?
Dr. Noah Craft, CMO VisualDx: VisualDx is a mobile app and e-record integrated online resource that is intended for health care professionals. In the 1980s, Dr. Art Papier, the founder of Logical Images, the company that produces VisualDx, worked with Larry Weed, the founder of the Problem Oriented Medical Record and SOAP notation. He was greatly influenced by Dr. Weed’s passionate articulation of the need for information systems that reduce the use of human memory in healthcare decision-making.
Dr. Papier also knew of the challenges primary care, emergency and hospitalist clinicians face in diagnosing the high volume of skin presentations they see. After years of relying on their memories and/or textbooks, Dr. Papier knew health care professionals could benefit from a quick, affordable, accurate and easy-to-use diagnostic tool. He created the first prototype in the mid-1990s, and the first version of VisualDx entered the marketplace in March of 2001. VisualDx was initially licensed by state health departments that placed the system in emergency departments to support rapid clinical diagnosis. Six states continue to license VisualDx to bolster infectious disease diagnosis and public health preparedness. Today, it is available through individual and institutional licenses to healthcare professionals around the country. An individual subscription costs $299 a year, and an institutional license is available at a much lower per-person cost. A 15-day trial of VisualDx is available at no charge.
Medgadget: Can you explain to us what makes VisualDx such a unique application?
Dr. Craft: It relies on our ability to process visual information more efficiently. Relying on a database of more than 100,000 peer-reviewed images, VisualDx presents health care professionals images of disease in a completely visual fashion. We know that visual pattern recognition and processing of visual information is a much more primal brain function that is instinctual and requires less energy but is quite sophisticated. For instance, we can recognize someone across a room very reliably in 1 second, while recognizing that same person from a paragraph of words would take much longer and may not be as reliable.
VisualDx also goes beyond medical atlases and other reference materials by representing disease variation. We taught (and often still teach) medical students to memorize “classic cases” and hoped they would generalize to variants when in actual practice. This does not work. People have a very difficult time recognizing patterns they have never seen. VisualDx captures variation, and unlike any other tool, it is optimized to display variation, whether it is due to skin color, patient age, body location, severity, or immune status.
VisualDx also educates and empowers patients. When a health care professional uses VisualDx to show a patient an image that matches that patient’s symptoms, this gives the patient great confidence in the diagnosis, because all humans have an innate ability to recognize the visual patterns on themselves and on the screen. It makes very complex thinking much easier and makes practicing medicine and thinking about complex diagnostic processes fun again. In addition, VisualDx is an excellent teaching tool, which has made it a favorite Smart Phone App for HarvardUniversity and University of Pennsylvania medical school students.
Medgadget: Which resources does VisualDx use for the medical images and information?
Dr. Craft: VisualDx is built from more than 15 years of purposeful image collecting from leading universities and individuals. Images have come from master medical photographers from around the world and are “curated” and reviewed by professionals. The textual content is peer reviewed and written by a panel of more than 100 medical experts. The Editor in Chief is Lowell A. Goldsmith, MD, MPH, and Dean Emeritus of the University of Rochester. In short we have collected, curated, written, and edited everything in VisualDx ourselves. You can imagine that because UpToDate is our long term partner and connects directly to our content, that we have the highest standards for quality and integrity for all of our content.
We receive feedback from users all the time and update and modify information quickly to respond to their feedback. We power the entire system with a structured knowledge database that has codified decades of medical information to create true knowledge that is accessible from multiple angles simultaneously. Because of this approach, everything we show the user when they are searching for help can be contextualized to the specific patient. For instance, the differential diagnosis of blisters is completely different in a neonate than it is in an adult with HIV.
Medgadget: With VisualDx you have created a diagnostic decision support tool. How do you envision the integration of VisualDx into daily practice and do you intend to replace information resources like textbooks, atlases and treatment protocols?
Dr. Craft: VisualDx is already integrated into medical practices and is already replacing textbooks and atlases. It is the only diagnostic decision support system to be widely adopted by clinicians nationally, with more than half the nation’s medical schools and more than 1,500 hospitals and large clinics, including the Department of Veterans Affairs, using it to reduce medical error by ensuring accurate diagnoses.
Our users have shared amazing stories of how VisualDx has helped them recognize rare diagnoses, such as secondary syphilis in an immigrant, Cryptococcosis in an HIV patient, parasites in travelers, and acute meningococcemia in an infant. Very few people use textbooks and atlases at the point of care anymore. They want quick and easy access to accurate information on their phones, iPads and desktop.
Medgadget: I have tried out VisualDx and found an extensive database of diagnoses, medical images and additional medical information. What will be the next step for VisualDx? Do you for example have any plans to also add more images like ultrasounds, X-rays, MRIs and microbiology slides?
Dr. Craft: We have already added pulmonary infectious disease radiography, and plan to include all pulmonary imagery. We will be expanding radiology to include musculoskeletal, abdominal, pelvic, and neuroradiology over time. We are adding the middle ear very soon, which is important to paediatricians and family medicine clinicians. We also will be adding ECGs. Currently we are adding skin pathology. We already have organisms such as snakes, spiders, reptiles, jellyfish and ticks in VisualDx. We will cover all forms of visual medicine and all of diagnoses, but we will do this deliberatively to carefully maintain the same high standards we have used for the past 14 years. We believe differential diagnosis is the basis for improving diagnostic accuracy, and we believe the visual representation of knowledge is critical in helping clinicians to see the relationships between diagnoses and the symptoms, signs and other findings that tie to diagnoses. Many of our customers embed the VisualDx search potential directly into the EMR now. As the EMRs are improved in the next few years, the value of tools like VisualDx inside the EMR will grow. As our tools are extended to include input from patients, they will strengthen the doctor-patient relationship and improve patient safety.
Link: VisualDx webpage
Earlier post from 2007 about VisualDx: VisualDxHealth: Visual Diagnosis Made Easy