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sepsis_29500.jpgSepsis: it's a complication that can be difficult to diagnose and that's why the Centers for Disease Control want patients to be proactive.

Sepsis is a clinical situation in which there is evidence of bacteremia with associated system response. Common sepsis findings include chills, rigors, fever, tachypnea, hypotension, skin lesions and shock. Diabetes, renal failure, alcoholism, neutropenia and advanced age can predispose patients to poor outcomes. 

A 2011 CDC study shows sepsis on the rise. To be proactive, the CDC wants to combat sepsis at the patient level: making the general public aware of its symptoms and having patients include sepsis in diagnostic discussions with their doctors. As part of their awareness, campaign, the CDC has created a fact sheet for patients.

Sepsis can present itself in many ways. Diagnosing sepsis through VisualDx, you can read up on what to look for, diagnostic pearls, best tests, and therapy, plus view more than 60 images of sepsis shown in children and adults. Need access to VisualDx? Start your free trial today!



A 2011 CDC study shows sepsis on the rise. To be proactive, the CDC wants to combat sepsis at the patient level.


The amount of information you must acquire as a medical student is truly astounding - and it is something that no amount of pre-med training can truly prepare you for. What perhaps can feel most overwhelming is not only the knowledge, but the application of that knowledge to real-life patients coming to you with real-life problems once you begin the clinical phase of your education.

The Utmost Importance of the Diagnosis

One of the most challenging parts of being a clinician can be arriving at a diagnosis that is not only correct but made in a timely manner. You learn quickly as a medical student that this is a huge issue: diagnoses that are wrong or come too late can come with a significant cost, both in terms of patient health and of economics - and it is no surprise that recent research found that 63% of those surveyed are either "concerned" or  "very concerned" about mistaken diagnoses.

Why is it so important? According, to the authors of Improving Diagnoses in Health Care,2 the diagnosis is part process and part classification scheme, and it is not only vital for patient care but, in the larger picture, also helps to dictate research, allocation of resources, payment/reimbursement, and general health care policy as well.  From the human point of view, of course, its importance to patient care is paramount, and authors note that, "when a diagnosis is accurate and made in a timely manner, a patient has the best opportunity for a positive health outcome because clinical decision-making will be tailored to the correct understanding of the patient's health problems."

Because the entire plan of care for a given patient is based on the diagnosis, everything that you do for this patient is based on, quite simply, being able to figure out what is wrong with them in the first place. There is a large body of scientific evidence to show that a correct and early diagnosis can make a huge difference in patient outcomes, not only for more widespread diseases like cancer3 and malaria4 but also for lesser-known conditions like meningococcal disease5 and osteonecrosis of the knee.6

How VisualDx Helps

Technology, of course, cannot take the place of either book knowledge or of the experiential knowledge that you gain through your clinicals as a med student and later on through your residency. But it can help. And one tool which is incredibly useful is the VisualDx app.7 VisualDx is designed to help clinicians - at every stage in their education - expediently and accurately diagnose diseases in order to begin effective patient treatment.

This app gives clinicians instant access to great visuals for each diagnosis as well as concise but thoroughly clinical information which includes particular signs and symptoms to look for, diagnostic and disease management "pearls," and guidelines for treatment. The app also covers many adverse events caused by medications and provides Sympticons, which illustrate symptoms in adults, children, and infants. This program is available for iOS through the App Store and through Google Play for Android devices.

Being a medical student - and gathering the academic and experiential knowledge that you need to become a good clinician - is an enormous challenge. But apps like VisualDx, while not replacing your own knowledge and instincts as a doctor, can help you to make an accurate diagnosis in the fast-paced, high-pressure world of modern medicine. 

About the Author


Brian Wu, PhD, is currently a 4th year medical student at the Keck School of Medicine at USC. He is the founder of Health Stories For Kids, a media company that creates educational and entertaining stories to teach patients and their families about health topics. Brian is pursuing a psychiatry residency and is a loving husband and father.





  1. McDonald KM, Bryce CL, Graber ML. The patient is in: patient involvement strategies for mitigating diagnostic errors. BMJ Qual Saf. 2013;22:ii33-ii39. Accessed July 30, 2016.
  2. Balogh EP, Miller BT, Ball JR, eds. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press; 2015. Accessed July 30, 2016.
  3. Vedsted P, Olesen F. Early diagnosis of cancer -- the role of general practice. Scand J Prim Health Care. 2009;27(4):193-194. Accessed July 30, 2016.
  4. Malaria: diagnostic testing. World Health Organization. 2015. Accessed July 30, 2016.
  5. Dellepiane RM, Dell’Era L, Pavesi P, et al. Invasive meningococcal disease in three siblings with hereditary deficiency of the 8th component of complement: evidence for the importance of an early diagnosis. Orphanet J Rare Dis. 2016;11:64. Accessed July 30, 2016.
  6. Jordan RW, Aparajit P, Docker C, Udeshi U, El-Shazly M. The importance of early diagnosis in spontaneous osteonecrosis of the knee - A case series with six year follow-up. Knee. 2016;23(4):702-7. Accessed July 30, 2016.
  7. VisualDx. Accessed July 30, 2016.

The amount of information you must acquire as a medical student is truly astounding - and it is something that no amount of pre-med training can truly prepare you for. 

handfootmouth.jpgFlorida State University is dealing with an unusual outbreak of hand-foot-and-mouth disease (HFMD). At least a dozen students have been reported to be infected. 

A condition that appears more commonly in babies and toddlers, HFMD begins with a mild fever, sore throat, cough, headache, malaise and diarrhea. Vesicles develop in the mouth and can later appear on the hands, feet and sometimes buttocks.

HFMD is highly contagious and spread by sneezing, saliva, or fecal material.

Suspect your patient has HFMD? Here's what to look for:

  • Small erythametous macules on oropharynx that are often painful
  • Lesions on hands, feet that start as erythematous macules and develop a central yellow-gray, oval or football shaped vesicle on an erythematous base - lesions tend to be oriented parallel to skin lines
  • Adult infection may have peri-oral involvement, desquamation of palms and soles and onychomadesis.

There is no vaccine available for treatment though several are in the later stages of clinical trails. HFMD is a self-limited viral infection that needs to be treated only symptomatically.

University officials cancelled school activities and are wiping down all living areas (dorms, fraternities, sororities, etc.) in the hopes of stopping the spread of HFMD.

VisualDx has more information about HFMD including more than 80 images of child and adult infection and a easy-to-share handout to share with your patient.

Florida State University is dealing with an unusual outbreak of hand-foot-and-mouth disease (HFMD). At least a dozen students have been reported to be infected. 

visualdx_logo320.jpgROCHESTER, NY [September 8, 2016] - Getting the right diagnosis is a key aspect of health care: It provides an explanation of a patient’s health problem and informs subsequent health care decisions. The Dartmouth-Hitchcock health system is investing in technology to improve diagnostic accuracy. The Lebanon, NH-based academic health system signed an agreement to deploy VisualDx to its clinicians for use at the point of care.

VisualDx is a web-based clinical decision support system that assists clinicians to quickly build a differential diagnosis. With its extensive medical image library, clinicians can easily see variations of disease to arrive at a fast, more accurate diagnosis. VisualDx is accessed through the electronic health record and via mobile devices. Dartmouth-Hitchcock clinicians will also access VisualDx through the Dartmouth College BioMedical Libraries Resources site that offers a suite of evidence-based medical tools for clinicians and students at the Geisel School of Medicine at Dartmouth College. The tool has been proven to enhance diagnostic accuracy and improve patient care.1-2

Dartmouth-Hitchcock has recognized that reducing diagnostic error is an important focus for its efforts to improve population health. The Institute of Medicine’s 2015 report, “Improving Diagnosis in Health Care” is a major driving force for this initiative. In the report, one of its goals highlights the need to “ensure that health information technologies support patients and health care professionals in the diagnostic process.”

“In an increasingly complex health care environment, it is important that patients receive the care they want and need, when well informed,” noted Dr. Robert A. Greene, Executive Vice President and Chief Population Health Management Office at Dartmouth-Hitchcock. “Partnering with VisualDx will enable our clinicians to provide more accurate and timely information to their patients, with the goal of producing better outcomes and better patient experience across the populations we serve.”

“Dartmouth-Hitchcock is national leader in population health and accountable care, and we are excited to bring our technology to the system and its clinicians” said Art Papier MD, CEO of VisualDx. “We recognize that to drive accuracy and patient satisfaction, we have to do better at the point of care. VisualDx allows primary care physicians and clinicians to have access to specialty-level knowledge, and a fast second opinion in seconds.  Referrals and consultations become more appropriate and primary care physicians and patients benefit.”

VisualDx is available both on desktop and mobile devices. The application contains more than 2,700 diagnoses and 40,000 curated medical images, spanning medicine.


About Dartmouth-Hitchcock: Dartmouth-Hitchcock (D-H) is a nonprofit academic health system serving communities in northern New England. D-H provides access to more than 1,000 primary care doctors and specialists in almost every area of medicine at Dartmouth-Hitchcock Medical Center; the Norris Cotton Cancer Center, the Children’s Hospital at Dartmouth-Hitchcock, four affiliate hospitals, 24 ambulatory clinics and through the Visiting Nurse and Hospice for VT and NH. The D-H system trains nearly 400 residents and fellows annually, and performs world-class research, in partnership with the Audrey and Theodor Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center.


  1. Papier A, Allen E, McDermott M. Visual informatics: real-time visual decision support. Poster presented at: American Medical Informatics Association 2001 Annual Symposium; November 3-7, 2001; Washington, DC.
  2. David CV, Chira S, Eells SJ, et al. Diagnostic accuracy in patients admitted to hospitals with cellulitis. Dermatol Online J. 2011;17(3):1.[PubMed].



VisualDx, the award-winning diagnostic clinical decision support system, enters into agreement with Dartmouth-Hitchcock health system.

mobile_acute_meningococcemiargb720.jpgYou can't memorize it all. That's why medicine is moving out of memory-based practice to evidence-based decision making. Changing the way we prepare the next generation of doctors and health care professionals will shape the diagnostic process in such a way that hopefully reduce diagnostic errors.

At VisualDx, we believe it's not only important for students to learn how to diagnose properly but also provide students the tools to confirm their diagnosis or to build a differential diagnosis to compare variations of disease to arrive at the accurate diagnosis.

A study published in Postgraduate Medical Journal looked at the role VisualDx plays in medical education and clinical practice. Fifty-one medical students and 13 dermatology residents participated in the study at the dermatology teaching clinic at China Medical University Hospital.

The study observed the students and residents as they diagnosed 13 patients: first without VisualDx; then, with VisualDx. The consultant dermatologist's diagnosis was used as the standard.

The study found that without VisualDx, the students and residents accurately diagnosed their patients 62.5% of the time.  With VisualDx, diagnostic accuracy increased to 81.25%.

The researchers concluded that an 18.75% increase in diagnostic accuracy could lead to an avoidance of misdiagnosis and medical resource waste and the possibility for better treatment. More studies (on a larger scale) are recommended by the researchers to confirm VisualDx's place in medical education. 

Read more on study.

What role can VisualDx play in medical education? A study out of China looks at its effects on student and resident diagnostic skills.

kapilandjodiined.jpg[August 24, 2016]  From Healthcare Informatics 

Although there has been widespread optimism expressed about the potential of application programming interfaces (APIs) and the FHIR (Fast Healthcare Interoperability Resources) standard, it may be a while before deployments are widespread. But that doesn’t mean they aren’t starting to find their way into provider organizations.

Last week I had the chance to interview Louis Krenn, M.D., chief medical information officer at five-hospital CoxHealth in Springfield, Mo. Cox’s hospitals use Cerner’s EHR platform and Krenn is leading the transition of its ambulatory practices from GE Centricity to Cerner.

One of the advantages of the switch is the ability to easily deploy SMART on FHIR apps, which run on top of the EHR. As Cerner notes, physicians can access these “pluggable apps” directly within their workflow to more easily visualize, interact and transmit health data.

The first example Krenn mentioned is a clinical decision support tool called VisualDx. With an initial focus on dermatology, VisualDx allows physicians to build a differential to evaluate the possibilities, compare variations, and improve diagnostic accuracy at the point of care.

“Especially from a primary care perspective VisualDx is appealing because dermatology is a large need, but it is something a lot of primary care doctors don’t have a lot of experience with,” Krenn said. So having that point-of-care tool available is important to us. We had a contract with VisualDx for a while before we instituted the SMART on FHIR piece, so we were familiar with the company and the technology.” He liked the tool, but you had to launch out to a separate website and put in user name and password, or you had to pull out a smartphone to use the mobile application. Now the app is embedded within the clinical record. “I am already logged into the application. I click another tab in my EMR, and it passes through credentials. I don’t have to log in to anything,” he said.

“SMART of FHIR allows the app to gather the clinical information about the patient to refine your search much faster. It sends how old the patient is, male or female, medications, allergies, anything on the problem list, and begins to refine your differential before you even ask,” he said. “When I go to the VisualDx tab in my Cerner record, as it loads, immediately it is already passing through to VisualDx that information. When I start to give the application additional clinical information, it is already taking into consideration the context of that patient. I could take the time to tell the application all this information manually, but that is going to take me a lot longer to get to my diagnosis. If we are using this at the point of care in front of the patient, we want to be as efficient as we can.”

VisualDx has been branching out beyond dermatology. You could search for lung cancer and it will give you radiologic images of what lung cancer might look like on a scan, he added.

Krenn said he is actively looking at other apps in the SMART on FHIR app gallery, including a bilirubin risk chart app and a pediatric growth chart app. “We are trying to negotiate for a license to [clinical decision support tool] UptoDate and they are interested in embedding with us through SMART on FHIR as well,” he added.

Krenn believes the “app store” model for modular improvements to EHRs is very promising. “Everybody has a smartphone in their pocket and everyone understands apps and add-ons. Even the layperson has heard the term API at least once and understands the concept,” he said. The ability to look in a store and find out what is available and see a quick video demonstration of it is definitely appealing since this is relying on folks external to your core EMR to provide you with this information. By having Cerner or another vendor create an app story similar to what Google and Apple have done is definitely beneficial.”

Krenn has been pleasantly surprised at the uptake of VisualDx now that it is embedded in the EHR. "We have seen increased usage based on having it conveniently available, and the usage has been sustained. On average, we have about 20 users per day, and 300 unique users per month, so it's not the same 20 users going back every day.”

Written by Healthcare Informatics Contributing Editor David Raths





“When I go to the VisualDx tab in my Cerner record, as it loads, immediately it is already passing through to VisualDx that information. When I start to give the application additional clinical information, it is already taking into consideration the context of that patient."

Web Based

If you can read this page, you likely have all you need to run VisualDx. It's that easy.

Browser requirements

VisualDx is a web-based application that runs in any modern browser using port 80 (or, optionally, port 443 for SSL). Browsers must have an active internet connection and have session cookies and JavaScript enabled.

Supported Browsers:
(Current version unless otherwise noted)
Internet Explorer 9+, Microsoft Edge, Chrome, Firefox, and SafariInternet Explorer 11+, Microsoft Edge, Chrome, Firefox, and Safari
Performance will vary with system hardware.

Mobile app requirements

VisualDx Mobile apps are available from the Apple Store and Google Play.

 android iconios icon
Hardware:Android phone or tabletiPhone, iPod Touch, or iPad
Operating System:Android OS 4.1 or higheriOS 9.0 or higher
All devices require 3G/4G or wireless connection.

VisualDx is available at over half the U.S. medical schools and over 1,600 hospitals and institutions. If your school or hospital/clinic has purchased VisualDx access - did you know you can create a personal account and have VisualDx with you whenever you need it on your phone or tablet?

Just follow the simple steps below:

mobiledownload1.pngstep1.pngFrom a clinical computer at your site, go to Once inside the VisualDx application, click on Get the Mobile App to create your personal account.





Search for VisualDx in the App Store or Google Play on the device with which you want to use the app.




Download the free app, enter the username and password you used to create your personal account and you are all set.


Download a PDF with these instructions.

Just a few simple steps and you'll be able download the VisualDx mobile app through your school or hospital.

The Dermatology Nurses’ Association is teaming up with the Rochester-based company VisualDx to provide accurate, informed decision-making at the point of care. VisualDx is a web-based diagnostic decision support system that includes 40,000 medical images and peer-reviewed expert information to improve diagnostic accuracy while the patient is still in the office.


The Dermatology Nurses’ Association (DNA) is a national, professional nursing organization comprised of a diverse group of individuals committed to quality care through sharing knowledge and expertise.  The core purpose of the DNA is to promote excellence in dermatologic care. The new partnership will provide special discounts for DNA members as well as additional outreach and promotional opportunities.


“VisualDx is a tool that will be a great resource to not only our members, but to their practices and patients,” said Linda Markham, RN, DNC, Executive Director of the DNA. “Our Board of Directors continues to have an open mind about new and innovative ideas to help our members be more successful in their careers, and VisualDx is a prime example.”


“As a dermatologist myself, I understand firsthand how our tool is valued in the field of dermatology,” said Art Papier, MD, CEO and co- founder of VisualDx. “This new partnership will help broaden our customer base so that more front-line clinicians can have access in order to improve care and patient satisfaction.”


The idea for a dermatology specialty nursing organization was spawned in 1981 to address the unique educational needs of health care professionals working in dermatology.  By 1983, the DNA elected its first officers and in in 2005 the NP Society was formed.  In 2009, the DNA launched its newest journal, The Journal of Dermatology Nurses' Association (JDNA). The organization has grown to over 2,000 members. Today, the DNA continues to strive to meet the educational needs of their members, and to improve the quality of patient care. 


VisualDx, available on computer, tablet or smartphone, is utilized by clinicians all over the world. It’s currently used in over 1,600 hospitals and large clinics. Customers have access to its custom differential builder, medical image library, and clinical information such as therapy options. 


Virginia Hanchett, MS, FNP, APRN-BC, DCNP, COCN, DNA Board of Directors, currently utilizes VisualDx in her everyday practice. “VisualDx is a wonderful evidenced based tool that broadens differential diagnosis for the benefit of patient outcomes.  It is the most concise ‘gold standard’ reference that I have seen in the age of digitalization in Dermatology. We are very proud to recommend this specially discounted program opportunity to our members in the Dermatology Nurses Association.  I have used it for over 12 years and its currency, efficiency, depth and breadth of information is so impressive I don't know how I would live without it,” said Hanchett.



About VisualDx: VisualDx is an award-winning diagnostic clinical decision support system that has become the standard electronic resource at more than half of U.S. medical schools and more than 1,600 hospitals and institutions nationwide.  VisualDx combines clinical search with a database of more than 40,000 of the best medical images in the world, plus medical knowledge from experts to help with diagnosis, treatment, self-education, and patient communication. Expanding to provide diagnostic decision support across general medicine, the new VisualDx brings increased speed and accuracy to the art of diagnosis. Learn more at

About DNA: The Dermatology Nurses’ Association is a non-profit organization comprised of over 2000 nurse practitioners, registered nurses, licensed practical and vocational nurses, medical assistants and others associated with dermatology nursing, who work in a variety of settings including clinics, academic institutions, private practice, public health centers, and government facilities. DNA offers education and training in fundamental and cutting-edge dermatology care and treatment through its annual convention, local chapter meetings, dermatology nurse and nurse practitioner certification review courses and expert workshops. The DNA’s National Headquarters is in Southern Pines, NC. Visit us at

VisualDx, the award-winning diagnostic clinical decision support system will provide exclusive discount to DNA members.

VisualDx, the leader in diagnostic accuracy, is showcasing its award-winning diagnostic clinical decision support system at #DHITS (Defense Health Information Technology Symposium) August 2-4, 2016 in Orlando, FL.

cernersmartfhirver2_720.jpgCheck out Booth 812 to discover how VisualDx improves decision-making at the point of care. VisualDx seamlessly integrates into the Cerner record, including FHIR, as was discussed at the recent HL7 FHIR Symposium Roundtable. This integration brings intelligence into the electronic health record while fitting right into the provider's workflow.

With VisualDx, the military can: 

  • Create a differential diagnosis across environmental, marine, CBRN, and general medicine.
  • Recognize and treat medication reactions quickly and accurately.
  • Access 40,000 of the best medical images.
  • Empower medics and IDCs with the right information at the right time and place.
  • Avoid unnecessary medevacs.
  • Identify global infectious diseases.

See why VisualDx is trusted by physicians and nurses all over the world. Accessible anytime, anywhere on the web, tablet, or smartphone.

VisualDx is showcasing its diagnostic clinical decision support system at DHITS August 2-4. See how it seamlessly integrates into Cerner and FHIR as it empowers medics and IDCs with the right information at the right time and place.