Visual-diagnosis software guides treatment of skin ailments

ROCHESTER, N.Y. — A 4-year-old boy arrived at an Iowa hospital with a fever, swollen lymph glands and various visible clues: a diffuse rash, cracked lips and peeling skin around his fingernails.

Dr. Mark Graber, an emergency room veteran, quickly suspected Kawasaki’s syndrome, a rare heart condition that can lead to fatal aneurysms. The boy had already visited several doctors and ERs “and the diagnosis was missed,” Graber said.

To ensure he was on the right path, Graber typed his observations into a visual-diagnosis software application that’s designed to pinpoint illnesses that appear on the skin, from chicken pox or Lyme disease to AIDS complications or anthrax exposure.

Honing in on an explanation for rashes, blisters or lesions might seem a fairly straightforward task. But thousands of diseases have visible symptoms, plus thousands of uncommon manifestations, and front-line doctors are often stumped.

Dr. Art Papier saw a growing need for a technological answer to the question, “What am I looking at?” as the ranks of medical dermatologists were steadily depleted in the 1990s by a shift to cosmetic surgery.

“You either train more skin experts, which we’re not doing, or you make the generalists smarter,” said Papier, a University of Rochester associate professor of dermatology who in 1999 co-founded Logical Images, the developer of VisualDx software.

VisualDx contains nearly 10,000 medical photographs culled from 1.2 million accumulated since the 1940s in private archives and colleges, chiefly New York University and the University of California at Los Angeles.

The software was first licensed to hospitals, medical schools and internists in March 2001.

The market grew dramatically after the October 2001 anthrax attacks killed five people, rattling a nervous nation. The software already had a biological warfare segment showing in vivid color the progressions of long-eradicated diseases like smallpox.

With the government allocating more than $1 billion a year to improve bioterrorism readiness, Logical Images has deals with big-name clients, from the federal Centers for Disease Control and Prevention to hospital systems in New York City and Washington, D.C.

Propelled by a $1.5 million Army contract in August to supply medical-training centers at 13 U.S. bases, its sales quadrupled this year to $4 million.

Hospitals are using the tool to handle a panoply of illnesses. Mississippi uses it to train doctors in tracking dozens of communicable diseases, such as syphilis, that by law must be reported, Papier said.

Priced anywhere from $200 to $20,000 annually, depending on the number of users, VisualDx helps in the vital task of moving health care “from a memory-based to a guidance system by structuring knowledge to solve problems,” he said.

In place of the century-old method of flipping through weighty medical atlases containing one or two pictures of each illness — usually the classic or severe symptoms — the software displays multiple high-resolution images of how an illness can present itself.

“You see different body locations, skin tones, stages of the disease,” said company President Mike O’Connor.

If doctors cannot guess what’s wrong, they click on a category — lump or bump, black scabs, raised lesions — and add in ever more detailed facts, such as a patient’s appearance, medical history, drug medications or travel abroad, to hone in on potential culprits.

Fitting into a category called “decision-support software,” the system “is not making the decision, it’s just helping to make it,” said James Cimino, a professor of medical informatics and medicine at Columbia University. “And, in fact, humans are pretty good at making decisions when they have the right information.”