La Maestra Community Health Center in National City, California, is not the kind of place that sees a lot of rare diseases. It’s a local health clinic, originally founded to cater to the city’s largely poor immigrant population. Dr. Alejandro Diaz, a pediatrician there, calls the clinic a “low resource setting.”
So, a few years back, when a 15-month-old baby girl was brought in with a cough, diarrhea, and a rash all over her body, Diaz assumed it was a garden-variety virus. But after sending the baby and her mother away with antihistamines, they were back the very next day. This time, the little girl’s rash had worsened, and her lips were swollen.
Unsure what could be causing the swelling, Diaz consulted a web-based tool he learned about during his residency at the Harvard UCLA Medical Center called VisualDx. He entered the child’s age and symptoms into the system, and it spit back a grid of photos of various conditions, ranked in order of most to least likely. He compared the images of rashes he saw on the screen to the little girl’s rash in front of him, and one of the photos caught his eye—a picture of a rare condition that causes inflammation in the blood vessels called Kawasaki disease.
“It’s one of those conditions where, if you’re not thinking of it, you’ll miss it,” Diaz says. “Doctors will say, ‘It’s a virus. It’ll pass,’ but it’s one of the few conditions where kids can die of a major heart attack.”
Luckily, that wasn’t the outcome for Diaz’s patient. After lab tests confirmed the diagnosis, he was able to get her the treatment needed to save her life. Years later, Diaz gives most of the credit for that fact to VisualDx. “Anyone who knows me knows I’m always singing its praises,” he says. “It’s like having an extra set of eyes without having other doctors in the same room.”
Launched in 2001 by Dr. Art Papier, a professor of dermatology and medical informatics at the University of Rochester, VisualDx is far from the newest tool for physicians. It’s already being used by more than 1,500 hospitals and clinics and being taught in 80 medical schools across the country. And yet, the introduction of mobile technology in medical settings, and the willingness of young doctors to use it, is driving massive traffic to the app.
VisualDX founder Dr. Art Papier. VisualDXMeanwhile, the recent outbreaks of Ebola and measles in the U.S. are forcing both hospitals and insurers to think proactively about how to predict and identify the next pandemic, and VisualDx is increasingly being held up as a crucial part of the solution.
Papier founded VisualDx because he believes that medicine is the one profession in which we train people extensively to wing it. “You go to medical school. You read. They test you on your memory. You apprentice for years, and then you’re expected to know it all,” he says. “That’s like telling a pilot to memorize every route in America. You wouldn’t get on the plane.”
It’s a problem that became clear to Papier early on in his career, working as the only dermatologist in a rural town right out of medical school. “I quickly saw that primary care doctors had difficulty with even common diseases,” he says. That’s one reason why one in every 10 diagnoses in the US is wrong, leading to 40,000 to 80,000 deaths every year, according to the Society to Improve Diagnosis in Medicine.
“I saw this real need to bring expertise to the generalist,” Papier says. So he decided to build a tool that would do just that. VisualDx, which now includes both a web and mobile app, consists of more than 100,000 peer-reviewed photos that correlate to more than 1,000 diagnoses. Physicians, who pay $29.99 a month for access to the app, can enter a patient’s symptoms as well as other potentially critical information, such as the patient’s age, where he or she has recently traveled, and where on the body symptoms like rashes or swelling are appearing. VisualDx then turns up a range of photos, and the doctor can click on any one of them to find out more about each condition.
Too Much to Look At
VisualDx is not much to look at. In fact, I highly suggest you don’t. The simplest of searches can turn up a panorama of gruesome photos of lesions in all the wrong places. Trust us—it’s gross. And yet, for physicians, these nausea-inducing images act as a kind of cheat sheet for diagnoses. While most other diagnostic tools on the market give doctors lengthy text descriptions of a condition, VisualDx starts with photos because it speeds up the process of making a diagnosis, which can be critical in places like emergency rooms.
According to Dr. Warren Wiechmann, an assistant professor of clinical emergency medicine at UC Irvine Health School of Medicine, most other tools first ask doctors for a diagnosis and then tell them everything they need to know about that condition. “Which is great if you know exactly what you’re looking for. However, as an emergency physician, I often see patients presenting with the simple complaint of ‘rash,’ and it is up to me to figure it out,” he says. VisualDx flips that model, using an algorithm to pinpoint the diagnosis that matches the symptoms.
Of course, there are drawbacks to this approach. For starters, not every condition manifests itself in a visual way. VisualDx addresses that issue by using diagrams, rather than photos, for those conditions, but of course, that’s not as effective as being able to see the actual symptoms.
But what Papier says is more challenging has been ensuring that doctors actually use the app instead of rushing to judgment on a diagnosis. One particularly egregious example was the case of Thomas Duncan, the Ebola patient who died last fall in a Texas hospital weeks after he was misdiagnosed and released from the same facility. Duncan, who was complaining of a fever and abdominal pain, told his doctors he had travelled to Liberia, but he was still sent home with the diagnosis of a less serious virus. Had his doctor had access to VisualDx, he would have seen that Ebola was the first diagnosis for people who travelled to Liberia and had similar symptoms.
Still, Papier says that the more comfortable young doctors are getting with using mobile technology at the point of care, the more they’re using the app. In 2014, alone, doctors looked a 60 million images on VisualDx. Papier sees that as progress.
“As a society, we tend to be reactionary to each crisis. We were reactionary to anthrax and smallpox, and then we’re reactionary to Ebola, and then it’s measles,” he says. “We don’t know what’s going to be next, and there’s no way the brain can memorize the next.”