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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+, Chrome, Firefox, and SafariInternet Explorer 11+, 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.


by M4, Medical Student

As a third-year medical student, my daily routine revolved around clinical duties, outside study with reference materials, and daily clinical image quizzes with VisualDx. The first two I certainly expected to improve my clinical acumen but I never anticipated the latter would intersect with patient care. The quizzes were simply meant to improve my pattern recognition skills, matching physical exam findings with specific disease processes.

That interpretation, however, was quickly dispelled during my surgery clerkship. On that clerkship, I had the opportunity to work one-on-one with my attending - the advantage of rotating at a branch campus. My attending gave me "first crack" at admitted patients and in clinic, testing my clinical skills and filling in my (admittedly large) blind spots.

No patient challenged me (and my attending) more than James*. This was his third admission to the hospital in the past few months or so. Our 24-year-old had a chronic wound on his leg that wouldn't heal. Despite several rounds of IV antibiotics and debridement, his course continued to worsen. My attending, as always, let me see him first.

He told me how the wound had started: a few months ago, he had barely nicked his leg against a side-railing exiting the bus. One week later, a little wound appeared and it kept growing. The only item in his medical history was ulcerative colitis and it had been well controlled for the past few years on a biologic.

The 3-cm wound on his anterior leg seemed to have pretty clean margins; no pus was draining; and it didn't have the horrible stench like so many previous diabetic ulcers. There was a little surrounding redness but nothing too impressive. This seemed nothing like the wounds I'd seen in wound clinic.

Something about his story seemed off. He didn't have diabetes, and vascular disease seemed unlikely with his physical exam. If antibiotics and debridement hadn't worked three times before, I suspected a fourth round wouldn't fix the problem.

I decided to write down "the pertinents" to figure this out. 24-year-old male, history of UC with chronic leg wound with pathergy that had progressed despite several courses of IV antibiotics and debridement. The wound's appearance reminded me of an image I had seen on a previous VisualDx quiz so I pulled out the application. I typed the most specific aspect of the wound I could think of: "pathergy". The second result on the list popped out to me: pyoderma gangrenosum. Reading the description, I realized this may well be his diagnosis.

I told my attending about my hunch, and he was willing to pursue it. One dermatology consult and biopsy later, our answer was confirmed. Those daily quizzes diagnosed our patient, and with a course of steroids (and no more debridement!) his wound healed.

*Patient's personal details have been changed for confidentiality.

As a third-year medical student, my daily routine revolved around clinical duties, outside study with reference materials, and daily clinical image quizzes with VisualDx. The first two I certainly expected to improve my clinical acumen, but I never anticipated the latter would intersect with patient care.

Harvard Medical School will host the HL7 FHIR Applications Roundtable July 27-28. The event highlights solutions to improve the electronic health record. VisualDx's CEO, Art Paper, MD, will be among the presenters on July 28 to discuss how the implementation of FHIR into the EHR improves diagnostic accuracy at the point of care. With FHIR and VisualDx, we provide intelligence within the workflow of the EHR.

cernersmartfhirver1_720.jpgVisualDx has partnered with Cerner to be one of the first commercial applications using FHIR of Cerner Millenium. VisualDx is a diagnostic clinical decision support system used in more than 1,600 hospitals and large clinics. Using the SMART/FHIR standard, the platform is able to obtain the patient's age, sex, problem list, and medication list to provide the clinician with VisualDx and images matching their specific conditions or drug reactions. 

As the Institute of Medicine reported in 2015, "most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences." Complexity, variation, and the sheer volume of patients can result in error. With VisualDx, we best show variation of disease to solve complex patient presentations. We do so within the workflow, including the all-important EHR. 

Details of Dr. Papier's presentation:

Thursday, July 28


Roundtable Program

 Follow us on Twitter @visualdx using #HL7FAR throughout the event to learn more.


VisualDx CEO, Art Papier, MD, is among the featured presenters at this year's HL7 FHIR Applications Roundtable. Learn how our diagnostic decision support system is bringing intelligence into the EHR workflow.


As seen on MedPage Today 7/25/16

In a keynote address last month, American Medical Association CEO James Madara, MD, likened many of the digital health products saturating the medical landscape to "snake oil," earning a host of comments and reactions in the medical tech world. Dr. Madara in particular focused his wrath on direct-to-consumer health apps and ineffective electronic health records (EHRs). But does hucksterism and hype end with digital health information in medicine? What about expensive new "miracle drugs" that almost bankrupt patients and are later proved to have minimal benefit? Or research breakthroughs that are news headlines and never pan out? The fact is that we are enamored with the latest and greatest - what's hot, what everyone is talking about. So let's add to the list of buzzwords: "analytics," "big data," "proteomics," "biomics" and "precision medicine" are just a few new words promising the transformation of your health. What fascinates me about the current health technology landscape is how the quest for new is diverting technology development away from the essential challenges of practicing clinical medicine today. I think this is what Dr. Madara is speaking to.

There are a billion outpatient visits in the United States each year, three on average for every American. If half the visits are for management of existing problems, the other 500 million visits include symptoms, complaints, and problems requiring answers. These visits where problems are to be solved and diagnoses made are inconsistent, spontaneous, and often maddeningly frustrating to patients. Patients present to their doctors (and now often nurse practitioners and physician assistants) expecting the most accurate and precise care possible. What they actually receive in care is entirely dependent on who they see, where they are seen, and other factors mostly out of their control. In the patient's eye, it is readily apparent that these doctor visits are ad hoc, unstandardized, and varied in results across practitioners. The result is 10%-20% of all diagnoses are just plain wrong.

Care is increasingly complex and yet fragmented between specialists. There is an ever growing body of medical literature and recommendations to keep up with. Increasing time pressure on physicians to conduct fast evaluations leads to missed patient histories and cognitive mistakes such as premature closure and diagnostic error. EHRs have mostly added to cognitive burden, not reduced it. These are core problems in medicine today.

Last year, President Obama announced a bold new focus on precision medicine. What new program in "precision medicine" should the President have announced first? Clinomics. I'm defining Clinomics as precision clinical care to deliver what medical science already knows. It entails bringing the excellence in pre-existing, readily available knowledge to the fingertips of the doctor and patient at the time of the visit and to the patient at home. This means highly relevant information applied to clinical decisions that are contextualized to the patient problems. This is information existing in the today's medical literature that is not being delivered to the decision-making moment, but easily could.

Clinomics is also defined by thoroughness and completeness in medical practice, and using information precisely to aid diagnostic, testing, and therapeutic decisions. Clinomics encompasses:

  • A thorough history and physical exam
  • Meaningful patient engagement
  • Shared decision making
  • Patient-contextualized digital information to aid decisions
  • An easy-to-use electronic record to support all of the above

If we focus on productive technology, we can bring back the joy of practicing medicine. Instead of clicking buttons to fulfill bureaucratic functions in bloated EHRs or working with apps that supply meaningless and superfluous information, we can fix the known repeated mistakes that anger and harm patients. The technology of Clinomics helps doctors with actual medical thinking. With Clinomics, patients marvel as their doctors use purposefully designed information tools that are much more powerful than random and imprecise Google searches.

Clinomics dovetails with the precision medicine of genomics, biomics, and proteomics and will provide such promising endeavors with context and an organizing principle around clinical medicine, leading to these new sciences accurately linking clinical phenotype to molecular information.

Tech plutocrats with billions for "moonshots," and those that must use the clichés of "disruption," "big data," "analytics" and "precision medicine" will think I am a Luddite. I'm not. Health information technology is the key to enhancing medical decision-making. And despite Dr. Madara's skepticism, consumer-focused applications are critically needed innovations that have the potential to transform health and the physician-patient relationship in the most positive way. However, innovators must also focus on technologies that address core needs in the exam room. Provide doctors with user interfaces and tools that work so they can do things like order the most sensible, appropriate, and cost-effective lab tests. Make sure the diagnosis is correct, and the therapy ideal. Understand medicine and the inherent ambiguity of medical decision-making. You cannot fix anything if you fail to understand and misstate the core problems. We can start fixing the broken here and now as we envision and invest in the future.



If we focus on productive technology, we can bring back the joy of practicing medicine. Instead of clicking buttons to fulfill bureaucratic functions in bloated EHRs or working with apps that supply meaningless and superfluous information, we can fix the known repeated mistakes that anger and harm patients.

montageuserfeedback.pngWe love hearing from you about VisualDx and how you use our app/tool in your everyday practice. Our customers are the bread and butter of the company; your success is our success. We strive to make VisualDx the best it can be so that doctors, students and other healthcare professionals can diagnose patients quickly and accurately.

Hearing from our customers is one of the best ways to make that happen. Earlier this year, we asked for your thoughts on VisualDx. We’ve compiled that feedback into a short video.

Many thanks to those listed below for participating in this video!

Dennis Porto, M.D., a dermatology resident at Henry Ford Health System

Matt Innes, M.D., a transitional intern at Tucson Medical Center

Jane Clark, M.D., a dermatologist at the Hamilton Medical Center

Roman Bronfenbrener, M.D., a dermatologist at Stony Brook University Medical Center

Yosef Seewald, a dermatology PA-C MPAS at The Dermatology Group, PC

Ashley Dietrich, an M4 at the Medical College of Wisconsin

Travis Morrell, M.D., a dermatology resident at Loma Linda University Health

Tyler Shelton, a physician assistant at Florida Emergency Physicians


If you would like to submit video feedback, email our Community Engagement Coordinator Lauren MacDonough at

We strive to make VisualDx the best it can be so that doctors, residents, students and other healthcare professionals can diagnose patients quickly and accurately.

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