Elizabeth Hinton, MSIS, AHIP
Reference Librarian, Informational Services
Rowland Medical Library
University of Mississippi Medical Center  

Description

VisualDX, a product of Logical Images, Inc., is a visual clinical support tool for diagnosing visually identifiable diseases, and an educational resource for health sciences students and residents. Additionally, it is an effective point-of-care reference and patient education instrument. The database covers over 1,300 pediatric and adult conditions with almost 30,000 images, and is an appropriate application for the fields of dermatology, emergency medicine, internal medicine, family medicine, pediatrics, ophthalmology, and dentistry. The images represent multiple ages and skin types and various stages of diseases.

VisualDX has an extensive editorial board. Two dermatologist senior editors lead a diverse group of physicians who serve as section editors for each discipline the database covers. Reviews of the published material are conducted continuously, and updates to the database are added quarterly.

Features & Functionality

Searching
VisualDX has its own easy-to-use search engine. Users have the option of searching by the name of a diagnosis, medication, or patient finding, or by describing the condition using the “Differential Builder” to build a clinical scenario. The search box on the home page provides auto-complete suggestions as the user types. After typing the name of a condition, the user is taken to the text and images page. This page lists ICD-10 codes, synopsis of the diagnosis, what to look for when diagnosing, diagnostic pearls, differential diagnoses and potential pitfalls, test recommendations, management, therapy, references, medications, associated findings, and a list of images. The user can select “patient handout” in the right corner to share patient information (with or without pictures) at the point of care. Each entry lists the authors and date of the last update. Clicking on “More Clinical Scenarios” will allow the user to change the skin color presented in the images and switch between adult and pediatric images.

The Differential Builder, which is accessible from the text and images page or from the home page, allows the user to tailor each search by choosing specific patient details. When adding to the clinical scenario from the text and images page, the user can click on the Differential Builder and add findings like lesion type, body location, key findings (timing of the affliction, fever, itching, etc.), or browse all findings (exposures, medical history, occupation, social history, travel, etc.). The user also has the option to type any findings into the “add findings” search box. Additionally, the user can check a box to show emergency diagnoses first in the images. When creating a search directly from the Differential Builder page, the user has a few different options: the search can begin with conditions such as bites and stings, marine exposures, acute pulmonary infection, or even public health and education scenarios. 

Help
Although VisualDX has an intuitive search engine, the help section is comprehensive and easy to navigate. From the home screen, Help can be found in the right corner. The user can select the full help document or a product tour, or can contact VisualDX support. The product tour takes the user through each page of the database, with explanations and options. The contact page presents several options: an email form, a link to Frequently Asked Questions with links to tutorials, a phone number for urgent problems, a feedback email form, and a form for requesting permission to use copyrighted VisualDX images.

Mobile Access & Resource Interaction
Through either an institutional and individual subscription, content can be accessed from any web-enabled device, including smartphones and tablets. In order to download the iPhone, iPad, or Android app, the user must first create a personal VisualDX account. Once a username and password is created, the application can be downloaded from the iTunes store or Google Play, then the user can login once the app is launched on the mobile device. Although the entire process takes a few steps, the mobile app is just as effective as its desktop counterpart. The iOS application’s additional quiz feature allows the user to take practice quizzes or play competitively in several categories: all specialties, dermatology, emergency medicine, family practice, infectious disease, internal medicine, dental & oral medicine, and pediatrics. Users can also accrue AMA PRA Category 1 CME Credits through the mobile app.

VisualDX has partnerships with several applications, like UpToDate, Lexicomp, the American College of Emergency Physicians (ACEP), and others listed here: http://www.visualdx.com/company/partners. Because it is built on the HL7 (Health Level 7) Infobutton standard, the product can be integrated into the electronic medical record and other third-party applications. UMMC’s separate licenses to both UpToDate and VisualDX allow for the integration of the two products. When navigating the UpToDate platform, if VisualDX has information related to a topic in UpToDate, an orange box will appear next to an image link. Clicking the link takes the user to VisualDX in a new window.

Additional Features
LearnDerm by VisualDX is an educational resource composed of interactive tutorials and self-study exams. The five lessons are titled The Skin Exam, Lesion Identification, Body Location & Distribution, Recognizing Configurations, and Morphologic Variation. The two quizzes cover morphology and distribution. Currently, LearnDerm can be accessed on the home page under “Health news and alerts.” In September, VisualDX plans to release a new interface, which will include the visual symptoms of conditions that lack common dermatological presentations.

Business Model

Visual DX typically offers one-year institutional contracts, and pricing varies by institution type and size. UMMC’s contract was negotiated through direct interaction with the publisher. The library received requests for the product from students, residents, and faculty, and usage was monitored during a trial period before the contract was negotiated. Due to the institution’s contract administration policy, the license cannot be automatically renewed. The UMMC library supports an academic medical center and a hospital, and the license is tied to the institutional IP range. In addition to hospitals and academic medical centers, VisualDX advertises its services for clinics and private practice, urgent care, public health, and accountable care organizations.

Subscriptions are available to individuals in two pricing options. “Essentials” can be purchased for $19.99/month or $199.99/year, and the “Complete” package costs $29.99/month or $299.99/year. VisualDX offers a percentage discount for students and residents wishing to purchase an individual subscription. All individual subscribers receive a free 30-day trial as part of a new subscription, and the subscription can be canceled at any point during the trial.

Breakthrough

VisualDX is a dynamic resource that can be used by multiple disciplines and in many different healthcare settings. UMMC students, faculty, staff, and librarians have been excited by VisualDX’s usefulness and usability during its first year of availability on campus, and the product may be of interest to libraries in a similar institutional environment.