VisualDx

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VisualDx A Decision support tool for visually
diagnosable disease
Ken Chee Regional Director, Asia Pacific
Ken.chee_at_thomson.com Aug 2005
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Content

• VisualDx
• What is it? Purpose and coverage
• Where Use?
• Technical Requirement
• Future modules
• Case study
• Appendix Editorial Board

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VisualDxWhat is it?(
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VisualDx - What is it?

• A decision support tool for detecting visually
  diagnosable diseases at the point of care
• It is a database of
• 10,000 photo images,
• Covering over 500 disease conditions
• Integrated with handbook length clinical
  information for diagnosis, testing, management
  and treatment

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VisualDx-What is it?

• Micromedex exclusively licensed from Logical
  Images, Rochester, New York State.
• Selected from 1.2 million images (collected since
  1940) from the worlds largest library of digital
  medical images in
• University Rochester
• New York University (NYU), and
• University California Los Angeles (UCLA)

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VisualDx- Purpose

• For early detection, recognition and treatment of
• Infectious diseases
• Adverse Drug Events (ADE) or drug eruptions
• Dermatology (adult, paediatric, light and dark
  skin)
• Sexually transmitted diseases (STD)
• Fever and rash
• Smallpox vaccinations
• Travel medicines and
• Bio-terrorism and chemical warfare.

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VisualDx- Coverage

• Covers
• Diagnosis sypnosis
• What to look for
• Best tests
• Differentials
• Management
• Therapy
• Ideal for use in conjunction with Micromedex
  databases on
• Disease
• Drugs
• Toxicology
• Patient education, and
• Complementary Alternative Medicine (CAM)

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VisualDxWhere Use?(
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VisualDx Where use?

• Essential for
• Emergency department
• Dermatology Department clinics
• Outpatient Department Family physicians
• Rural Tele-medicine
• Anti bio-terrorism

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Emergency Department for Infectious Disease

• Search by single or multiple findings such as
• Morphology
• Distribution
• Symptoms
• Signs
• Medications
• Exposures
• Occupations
• Medical history
• Travel

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Dermatologuy Department clinics

• Covers
• Adult Paediatric
• Dark skin
• Dermatologist choose a module clinically relevant
  to the patients presentation, Eg.
• Lesion
• Morphology
• Body location
• Symptoms
• Signs
• Medical history
• Travel

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Dermatologuy Department clinics

• Covers
• Adult Paediatric
• Dark skin
• Dermatologist choose a module clinically relevant
  to the patients presentation, E.g.
• Lesion
• Morphology
• Body location
• mean
• Signs
• Medical history
• Travel

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Outpatient Department Family physicians

• 10-20 outpatient clinic visits include at least
  one skin complaint
• VisualDx assists in rapid and accurate diagnosis,
  therapy and clinical management of patients with
  a visual component to their presentation
• Benefits -
• Reduce incorrect or delayed diagnosis and
  treatment
• Eliminate extraneous tests
• Improve clinician efficiency and patient
  satisfaction

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Rural and Tele-medicine

• VisualDx
• Brings valuable clinical visual information to
  under-resourced rural community
• Makes more efficient and effective use of
  resources when used in conjunction with
  tele-medicine at the point of care.

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Anti-bio-terrorism

• VisualDx
• Provides critical diagnostic tool to law
  enforcement units in the war against terrorism,
  e.g. Anthrax
• Washington DC Emergency Health Medical Services
  
• Provides VisualDx to 20 public health clinics and
  10 major hospital Emergency Departments.
• New York City Department of Health
• Provides VisualDx to 40,000 physicians city-wide
  on the City Health Alert Network (NYCHAN) and 20
  key hospitals

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Anti-bio-terrorism Smallpox Vaccination

• VisualDx smallpox vaccination training materials
  provided to
• US Center for Disease Control Prevention (CDC)
• US Health Human Services (HHS)
• Public Health Agency of Canada
• Lgence de sante publique du Canada
• State local department of health in the USA
• Becton, dickinson Co. for distribution in
  Europe

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VisualDx effectiveness study

• Objectives
• Assess physician diagnostic accuracy when using a
  visual decision support tool in comparison with
  reference textbooks
• Organizer
• University of Rochester, Center for Future health
  Study
• Methodology
• 4 case presentations with pictures in the
  reference text, and of sufficient difficulty to
  require a physician to seek reference in solving
  the case
• Subjects
• A mix of 50 emergency, internal medicine, GP and
  dermatologists

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VisualDx effectiveness study

• Process
• Training was provided using a 5-minute script to
  demonstrate the basic VisualDx functionality
• Each case was presented on a single placard with
  images.
• The subject used either the text book, atlases or
  VisualDx
• Conclusion
• Correct diagnosis improved by 124 among
  non-dermatologists.
• The results suggests advantages in using VisualDx
  over text books and atlases.
• The results were published in a poster at the
  American Medical Informatics Association (AMIA)
  2001 Annual Symposium, Software Improves
  Diagnostic Accuracy with Minimal Training.

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Technical Requirement

• Available on
• Standalone CD
• Windows NT 4.0
• Windows 2000 and XP
• RAM 128MB or more
• Free disk space 860MB
• Local Area Network
• Apache or IIS 5 (or higher) webserver
• RAM 256MB, 512 MB
• 940MB free disk space
• Internet Explorer 5.5 or Netscape 4.79 or higher
• Monitor resolution 1024x768 pixels

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Future Modules

• Are
• Oral Medicine
• Ophthalmology
• HIV/AIDS and immuno-compromised
• Derma-pathology
• Dermatology for neonates or infants
• Nail diseases
• VisualDx replaces
• John Hopkins Atlas
• Iowa Atlas
• Erlangen Atlas from Germany
• Dermis dematology atlas

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Thank you for your attention.Any Questions
?Ken.chee_at_thomson.com?
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VisualDx Demonstration

• Case study
• Your patient is a 50 year old male, presenting
  with non-scaly papules on his extremities. He
  does not have a fever, but is overweight and has
  diabetes. What is his diagnosis?

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AppendixEditorial Board
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Editorial Board

• Main Editors
• International Tropical Medicine
• Dermatology - General
• Dermatology - Paediatric
• Infectious Disease
• Emergency Medicine
• Immunology-HIV
• Obstetrics Gynaecology
• Ophthalmology
• Oral Medicine Dentistry
• Pharmacology
• Radiology
• Bio-terrorism

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Main Editors

• Lowell Goldsmiths MD MPH
• Editor in Chief
• Art Papier MD
• Editor, Chief Medical Informatics Section
• Nancy Esterly MD
• Editor, Paediatric Dermatology Section
• Tener Goodwin Veenema, PhD, MPH, MS CPNP
• Editor, Emergency Preparedness Section
• Marvin Turck, MD
• Editor, Infectious Disease Section
• Ken Allbek, MD, PhD
• Editor, Bio-terrorism Section

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Editors International Tropical Medicine

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Editors International Tropical Medicine

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Editors International Tropical Medicine

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Editors International Tropical Medicine

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Editors Dermatology - General

• Lowell A. Goldsmith, MD, MPH
  Editor-in-ChiefDean EmeritusUniversity of
  Rochester School of Medicine and
  DentistryProfessor of DermatologyUniversity of
  North Carolina School of Medicine     
• Art Papier, MDChief Medical Informatics
  EditorAssistant Professor of DermatologyUniversi
  ty of Rochester School of Medicine Affiliate
  University of Rochester Center for Future
  Health     
• Robert Baran, MDNail Disorders EditorProfessor
  of DermatologyNail Disease Centre Cannes
  France    
• Robert Chalmers, MD, MRCP, FRCPAssistant
  International Section Editor - Western
  EuropeConsultant DermatologistSalford Royal
  Hospitals NHS TrustCentral Manchester Hospitals
  NHS TrustRoyal Bolton Hospital NHS
  TrustManchester, England

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Editors Dermatology - General

• Benjamin K. Fisher, MD, FRCP(C)Male Genital
  Disease EditorProfessor EmeritusUniversity of
  Toronto Medical School     
• Paul Kelly, MDEthnic Dermatology
  EditorProfessor, Charles R. Drew University of
  Medicine and Science Clinical Professor of
  DermatologyUniversity of California, Los Angeles
  School of MedicineChief, Division of Dermatology
  and Staff Physician, L.A. County / Martin Luther
  King, Jr./ Drew Medical Center     
• Thomas O. McMeekin, MDCosmetic Dermatology
  Section EditorClinical Professor of Dermatology
  and PediatricsUniversity of Rochester School of
  MedicineClinical Assistant Professor of
  DermatologyState University of New York at
  Buffalo
• Mary Gail Mercurio, MDHair and Scalp Disorders
  Section EditorAssistant Professor of
  Dermatology, University of Rochester  

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Editors Dermatology - General

• Larry Parish, MDInternational Section
  EditorDirector, Thomas Jefferson Center for
  International Dermatology
• Bertrand Richert, MD, PhDNail Disorders
  EditorAssistant Clinical ProfessorDermatology
  Department, University of Liège     
• Mike Tharp, MDTherapeutics EditorThe Clark W.
  Finnerud, MD Professor Department of
  DermatologyDermatology Chairman,Presbyterian-St.
  Lukes Medical Center, Chicago, IL  

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Editors Dermatology - Paediatric

• Nancy Esterly, MDPediatrics Section
  EditorProfessor Emeritus of Dermatology, Medical
  College of WisconsinEditor-in-Chief, Pediatric
  Dermatology Journal    
• Cynthia Christy, MDPediatrics EditorAssistant
  Professor of PediatricsUniversity of Rochester
  School of Medicine      
• Sheila Galbraith, MDPediatric Dermatology
  EditorAssistant Professor of Dermatology
  Clinical InstructorPediatric DermatologyMedical
  College of Wisconsin     
• Lynn Garfunkel, MDPediatrics EditorAssistant
  Professor of PediatricsUniversity of Rochester
  School of Medicine      
• Sue Lewis-Jones, FRCP, FRCPCHPediatrics
  EditorConsultant Dermatologist Pediatric
  DermatologistNinewells Hospital and Medical
  School

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Editors Dermatology - Paediatric

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Editors Infectious Disease

• Marvin Turck, MDInfectious Disease Section
  EditorProfessor of MedicineUniversity of
  Washington, Seattle    
• William Bonnez, MDInfectious Disease
  EditorAssociate Professor of MedicineUniversity
  of Rochester     
• Bart Currie, MDInfectious Disease EditorHead,
  Tropical and Emerging Infectious Diseases
  DivisionMenzies School of Health Research,
  Darwin, NT, Australia     
• Vincent Fulginiti, MDInfectious Disease
  EditorProfessor EmeritusUniversity of Arizona
  Health Sciences Center     
• William Van Stoecker, MD

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Editors Emergency Medicine

• Tener Goodwin Veenema, PhD, MPH, MS,
  CPNPEmergency Preparedness Section
  EditorAssociate Professor, School of Nursingand
  School of Medicine Dentistry    
• Sandra Schneider, MDEmergency Medicine
  EditorChairperson, Department of Emergency
  MedicineUniversity of Rochester School of
  Medicine

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Editors Immunology-HIV

• Marcus Conant, MDHIV and AIDS Section
  EditorClinical Professor of Dermatology,
  University of California    
• Ncoza Dlova, MDHIV and AIDS Section
  EditorSenior Consultant / LecturerDepartment of
  Dermatology, Faculty of Health SciencesNelson R.
  Mandela School of MedicineUniversity of Natal,
  Durban

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Editors Obstetrics Gynecology

• David Foster, MDObstetrics and Gynecology
  Section EditorAssociate ProfessorDepartment of
  Obstetrics and GynecologyUniversity of Rochester
  School of Medicine
• Lynne Margesson, MDObstetrics and Gynecology
  Section EditorAssistant ProfessorDepartment of
  Obstetrics and GynecologyDartmouth Medical
  Adjunct School

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Editor Ophthalmology

• Peter Rubin, MDOphthalmologic Surgery Section
  EditorAssociate Professor, Harvard University
  Medical Center

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Editor Oral Medicine Dentistry

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Editor Pharmacology

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Editor Radiology

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Editor Bio-Terrorism