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THIS WEEK, VisualDx released an update to the web application of VisualDx. We have been listening to your feedback and made feature additions and changes based on your comments.

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1. Updated look and feel for the web application homepage.

The homepage has a new look with a Quick Start Differential Builder button for users who want to quickly build a differential from common chief complaints. Clients with logos will notice it now appears on a white background. These changes will also be coming to mobile platforms over the next few weeks.

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2. More images!

We’ve added nearly 5,000 new images to VisualDx since March, bringing the image count to 40,000! Many of the new images are radiology and dermatology images. Pictured above are two such images. At left is a clinical image of aquagenic wrinkling of the palms - an example of a recently added rare condition. On the right you can see an x-ray image of the foot that has been added to the rheumatoid arthritis diagnosis. We previously covered rheumatoid arthritis, but only as related to the skin. We're pleased to add radiologic images as a more comprehensive illustration of this common disease. Additionally, users may notice that we now have a total of 3,200 SympticonsTM in VisualDx.

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3. Image filter within a diagnosis.

We’ve developed a helpful new feature for viewing images within a diagnosis - users can now apply filters. The main filters to quickly find an image include the ability to:

  • filter either by multiple or single lesions
  • filter by type of skin pigmentation from Type I - Type VI or a combination of those
  • filter by different image types such as clinical photos, radiology, histopath/lab, or Sympticon
  • filter by body location
  • OR combine any of the filters above to further refine your search

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4. Updated look and feel to the Diagnosis Details page.

We’ve responded to user feedback and improved the look and feel of the Diagnosis Details page. Each change is designed to make the page easier to navigate, read, and access important information.

  • The word "View" was added to the “View All Images” blue button in the top right of the page and made to look more like a clickable button as opposed to a header.  
  • Links to the Patient Handout, Print, and Images were added to the top of the details to help users easily access those features.  
  • The diagnosis title and age were re-styled with a dropdown arrow.
  • The gender was removed unless the user is in the anogenital module.
  • In the text area, a gray background was added and each section of text was given it’s own distinct card-type look and feel.

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5. Dynamic links within a diagnosis.

If your site uses dynamic links, they now appear in the left hand navigation of the diagnosis. In this example, a doctor may click on the dynamic link and be taken to the page to report the case of secondary syphilis as they are required to do.

These updated features will soon be available in our iOS and Android apps. As always, we want to hear from you on the product. Please contact us anytime.

This week, VisualDx released an update to the web application with iOS and Android apps updates coming soon. We have been listening to your feedback and made feature additions and changes based on your comments.

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A 40-year-old male with a history of alcoholism presents with abdominal distention and hematemesis. A 25-year-old African American female presents with a chronic cough with bilateral hilar lymphadenopathy seen on chest imaging. A 35-year-old intravenous drug user presents with fever, heart murmur, and splinter hemorrhages seen on extremity examination.

Those who have gone through medical training likely can quickly identify the above disease scripts as a bleeding esophageal varix, sarcoidosis, and endocarditis. This is the beauty of formal medical education; it ingrains in trainees a kneejerk ability to identify and diagnose textbook presentations of the diseases that present to clinics and hospitals everyday. However, while this system allows clinicians to readily identify common presentations of common problems, if one changes just a few clinical variables, this ability to quickly and decisively identify a root cause of the patient’s symptoms breaks down. For example, if we consider instead a 60-year-old female with no past alcohol abuse who presents with hematemesis, the diagnosis of bleeding varix may not come as quickly to mind. This is just one example of the issue clinicians face when encountering uncommon presentations of common problems.

While seasoned medical providers have the benefit of years of experience to help identify and diagnose these atypical presentations, for those of us just entering the field these cases pose increasing diagnostic challenges. With such an apparent and pervasive issue of medical and diagnostic errors1,2 at hand with the potential to negatively impact patients, what safeguards can physicians and trainees employ to reduce the prevalence of diagnostic and treatment error in their practices?

loganjonesquote.jpgBefore the advent of the internet and the rapid expansion and integration of technology in patient care, if a clinician had a clinical question they would have to hold onto the question until they had access to a library or other sources of text. Now in the 21st century, with the ongoing expansion of digital integration into our daily routines, the entire body of medical knowledge is just a click of a mouse or the tap of the screen away. Although this sounds good in principle, studies have shown that medical providers struggle to properly wield non-medically oriented resources like Google or even PubMed to answer patient care questions3-5. In response, numerous point-of-care medical decision support programs have emerged that can provide quick and concise answers that utilize peer-reviewed literature to help clinicians practice evidence-based medicine. These resources stand to help expedite the process of finding answers to questions that arise in patient care. Early evidence would even suggest that their broader implementation has observable improvements on patient outcomes6.

Despite slowly growing evidence that the utilization of electronic point-of-care decision support resources can help inform clinicians to improve their practices and in turn patient outcomes9-10, our institutions of medical education have been slow to formalize education surrounding the use of these tools. The physician of tomorrow will likely be expected to be masters of integrating the ever-expanding medical knowledge maintained by these resources with the clinical skills and professional abilities to care for our patient populations. So, until our institutions establish the expectation for education on these tools, it is up to each of us as professionals to inform and educate ourselves on how to use every tool available to care for patients - including point-of-care clinical decision support resources.

Throughout my own educational experiences, I have used many different programs and find that while none of them offers a “one size fits all” ability to help with all questions, several have made it to my top-pick category. Below are some of my top choices and how I find them useful. Ultimately, it is impossible, and frankly unsafe, to expect clinicians to learn and memorize the exponentially growing body of medical knowledge. Hence, as with basic procedural skills such as starting an IV and suturing a simple wound, all clinicians should be expected to be competent in the cognitive skill of augmenting their practices by accessing appropriate resources in a point-of-care fashion in the care of their patients.

 

  • VisualDx: "Differential expander" - Born with the intention of assisting in the diagnosis of dermatologic conditions and visible lesions. A must have for any clinician because weird rashes are always difficult to diagnose. Also, recently updated to include broader differentials for an even more robust, general medicine differential diagnostic engine. Great for visual learners – expanding to include pathology and microbiology images and radiography to support diagnostics and education.
  • Epocrates: "How do I treat this?" - The basic service offers drug interactions, pill identification, clinical practice guidelines, and other helpful resources. The full version offers user expanded access to disease monographs, lab interpretations, and evidence-supported treatment protocols.
  • UpToDate: "I have 10 minutes to learn about X before rounds" - An evidence-based clinical decision support system authored by physicians to help clinicians make the right decisions at the point of care. Provides a "medium" depth dive into pathophysiology, pharmacology, diagnostics, and treatment of thousands of diseases. Tables are charts are often concise and provide great direction on how to workup and manage medical/surgical problems.
  • Figure 1: "General knowledge expansion" - This community medical-image sharing application allows healthcare workers to share photos and discuss cases on a HIPAA compliant platform. You get to see a "once in a career" disease presentation every day.
  • Assorted Screening and Guideline Applications: "Healthcare maintenance / chronic disease management" - The screening and interventions found in these applications don't take up space in my brain, but they do on my iPhone. They have many detailed components and are easy to use at bedside – just don't forget to tell your patient you're looking up their CVD risk and not texting about dinner plans. My short list: AHRQ ePSS (USPSTF recommendations), CDC Vaccine Schedules, ADA SoC (Standards of Care), ASCVD Risk Estimator, and a link to the FRAX calculator. 


About the Author

loganjones320.jpgR. Logan Jones is a fourth year medical student at the University of Nebraska Medical Center (UNMC) and has a strong interest in medical education and healthcare policy. Logan has served in numerous leadership roles at UNMC, the Nebraska Medical Association, and The American Medical Association. His main areas of focus are Competency-Based Medical Education, Graduate Medical Education finance reform, and Healthcare Technology Innovation.  Logan also has a strong interest in Antimicrobial Stewardship and plans on pursuing a career in Infectious Diseases. He enjoys spending his free time cooking, maintaining his wellness through exercise and yoga, and listening to NPR and his favorite podcasts.


References

  1. Makary MDaniel M. Medical error—the third leading cause of death in the US. BMJ. 2016:i2139. doi:10.1136/bmj.i2139.
  2. Harvard School of Public Health. THE PUBLIC’S VIEWS ON MEDICAL ERROR IN MASSACHUSETTS.; 2014. Available at: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/94/2014/12/MA-Patient-Safety-Report-HORP.pdf. Accessed June 21, 2016.
  3. Hoogendam A, Stalenhoef A, de Vries Robbé P, Overbeke A. Answers to Questions Posed During Daily Patient Care Are More Likely to Be Answered by UpToDate Than PubMed. J Med Internet Res. 2008;10(4):e29. doi:10.2196/jmir.1012.
  4. Sayyah Ensan L, Faghankhani M, Javanbakht A, Ahmadi S, Baradaran H. To Compare PubMed Clinical Queries and UpToDate in Teaching Information Mastery to Clinical Residents: A Crossover Randomized Controlled Trial. PLoS ONE. 2011;6(8):e23487. doi:10.1371/journal.pone.0023487.
  5. Krause R, Moscati R, Halpern S, Schwartz D, Abbas J. Can Emergency Medicine Residents Reliably Use the Internet to Answer Clinical Questions?. Western Journal of Emergency Medicine. 2011;12(4):442-447. doi:10.5811/westjem.2010.9.1895.
  6. BONIS P, PICKENS G, RIND D, FOSTER D. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. International Journal of Medical Informatics. 2008;77(11):745-753. doi:10.1016/j.ijmedinf.2008.04.002.
  7. Ellsworth M, Homan J, Cimino J, Peters S, Pickering B, Herasevich V. Point-of-Care Knowledge-Based Resource Needs of Clinicians. Appl Clin Inform. 2015;6(2):305-317. doi:10.4338/aci-2014-11-ra-0104.
  8. Duran-Nelson A, Gladding S, Beattie J, Nixon L. Should We Google It? Resource Use by Internal Medicine Residents for Point-of-Care Clinical Decision Making. Academic Medicine. 2013;88(6):788-794. doi:10.1097/acm.0b013e31828ffdb7.
  9. Fiander M, McGowan J, Grad R, Pluye P, Hannes K, Labrecque M, Roberts NW, Salzwedel DM, Welch V, Tugwell P. Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD004749. DOI: 10.1002/14651858.CD004749.pub3.
  10. Cook D, Enders F, Linderbaum J, Zwart D, Lloyd F. Speed and Accuracy of a Point of Care Web-Based Knowledge Resource for Clinicians: A Controlled Crossover Trial. Interact J Med Res. 2014;3(1):e7. doi:10.2196/ijmr.2811.

 

 

 

 

 

 

"While seasoned medical providers have the benefit of years of experience to help identify and diagnose these atypical presentations, for those of us just entering the field these cases pose increasing diagnostic challenges." Guest blogger R. Logan Jones discusses the integration of clinical support resources in modern medical education.

Share content with patients on Android mobile

How individual users can claim CME credits on Android mobile

Take the VisualDx quiz on Android mobile

Make the most of Smart Search on Android mobile

Build a differential diagnosis on Android mobile

iosdifferential720.jpgIf you're just starting out with VisualDx or need a refresher on the new version, we have you covered with our new mobile tutorials.

VisualDx is the best differential diagnosis tool available, with the ability to search by diagnosis, chief complaint, medication, or other finding such as travel. With over 40,000 images available and exclusive Sympticon™ technology, students, residents, and clinicians have the world's fastest second opinion in their pocket.

Whether using an iPhone, iPad or Android device, we show you how to use VisualDx to its full capabilities. Click on the links below to watch.

iPhone: Differential Builder, Smart Search, Share Content with Patients, Quiz, Claim CME Credits

Android: Differential Builder, Smart Search, Share Content with Patients, Quiz, Claim CME Credits

Learn everything there is to know about the VisualDx app on any iPhone or Android device. 

oralcarcinoma.jpgThe power of visualization.

As it turns out, we tend to learn better by interpreting information using more than one sense.

And a new study out in JAMA Internal Medicine continues to drive home this point.

Images on cigarette packaging showing smoking’s negative effects (“pictorial warnings”) were more effective than standard text warnings in getting active smokers to start to quit, according to new research out of UNC-Chapel Hill. The 4-week trial included close to 2,000 smokers randomized to receive packs of cigarettes with graphic images or the current text-only Surgeon General warning.

The images included rotting teeth, a side-by-side comparison of a healthy and diseased lung, and a man smoking out of his tracheotomy hole. ((**Pictured above is an oral squamous cell carcinoma from VisualDx's medical image library.**)) Up to 80% of oral SCCs are associated with cigarette smoking.

The study’s numbers were modest. During the trial, 40% of smokers with the graphic image packs attempted to quit versus 34% of smokers with the standard U.S. warning. 5.7% of the participants with the image packs actually stopped smoking for at least a week by trial’s end, compared with 3.8% of smokers with the text warnings. But researchers believe that if image packs were implemented across the country, the numbers could be significant.

The negative health effects of smoking have been widely known for years. But it seems actually seeing the effects at the point of deciding to purchase a pack or pull out an actual cigarette to smoke makes somewhat of an impact.

Visualization is at the core of VisualDx. And while we’re not in the business of smoking cessation, we are in the business of reducing diagnostic error and increasing patient safety. We do that by offering the world’s best and biggest medical image library, presenting variations of disease and visualizing disease through Sympticons – icons that use the human body to demonstrate the organs the disease affects and its symptoms – to enhance physician recognition and patient understanding.

Visualization is a powerful tool whether it's stopping smokers from taking a puff or helping doctors diagnose disease.

kapilandjodiined.jpgSpeed is a necessity. Accuracy is essential. How do you achieve both at your ACO?

Visit VisualDx at the National Accountable Care Organization Summit June 9 and 10 at Booth 18 and find out how.

VisualDx has one mission: improve diagnostic accuracy at the point of care. Tackle challenging diagnoses by building a custom differential in seconds. Use the power of visualization by seeing disease variations with 40,000 medical images and exclusive SympticonTM technology.

VisualDx puts medicine's fastest second opinion right at your fingertips. See why we're used at over 1,600 hospitals and large clinics.

 

 

Speed is a necessity. Accuracy is essential. How do you achieve that at your ACO?