MGMA · Business Solutions: Using Visuals and Graphics to Reduce Diagnostic Error
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In this episode of the Business Solutions podcast, we speak with Dr. Art Papier. Papier is CEO and co-founder of VisualDx, a software that can provide clinicians with assistance in making accurate diagnoses.
Editor’s note: The following Q&A has been edited for length and clarity.
Q: Who is VisualDx? What do you guys do there?
A: We’re a physician-led company that developed technology to improve decisions in the exam room. There's a real need now to not think we can memorize everything in medicine, but to use evidence as we work. And it's no longer good enough just to put a book online, so we developed this concept of the visualization of medical complexity. So it started (20 years ago) as really helping non-dermatologists with dermatologic diagnosis. And we didn't name this technology ‘DermDx’ because we always had the intention to broaden this to any chief complaint and cover medicine widely. So we're really an in-the-exam-room tool to speed decisions.
Q: I didn’t realize you’d been around 20 years. Talk a little bit about the formation. Were you there from the start?
A: When we started, we really were a public health informatics company working in bio preparedness. You might remember anthrax was spread in the mail. And our company had a contract with the federal government, with the CDC. We had contracts with state and city health departments. And during the interval since that beginning, with the launch of the iPhone in 2008, we were one of the first apps on the iPhone, bringing the technology right into the pocket of a busy practitioner. We grew the licensing to (where) over 2,300 hospitals and large clinics use VisualDx, over 100 academic centers use VisualDX, and the entire VA medical system is a subscriber. ...
So our company, really, our DNA is infectious disease. Not only that, but dermatology and other areas of medicine. But there's been a lot of interest in what we do for two or three reasons out of the last three years and the three reasons are COVID, monkeypox, and diversity, equity and inclusion. And I bring that up because ... we were and are the only technology, really, to do the skin presentation of disease equitably. And you didn't hear me say dermatology, you heard me say the skin presentation of disease. Because when people say dermatology they think psoriasis, acne, warts, skin cancer. They don't think about life threatening infections or drug reactions appearing on the skin that are, really, internal diseases, very serious diseases. And they're not thinking about how those diagnoses can be missed. …
Over the last two or three years, in addition to all these changes we’re seeing because of public health crises, we're seeing this real need to bring equity to medical decision-making. … There are not enough nurses; there's also not enough physicians. And so that means that everyone, whether it's an MD, a nurse practitioner, physician assistant, everybody has to be practicing efficiently and smartly, to avoid burnout. And I think there's nothing more frustrating than being busy, and having to hunt and peck, to find the right information when you know, the information is available, but you don't have it at your fingertips. And so that's what we're really thinking about, ‘What is the cockpit of medicine?’ Pilots have tools in that cockpit, that are purposely designed to fly the plane. Clinicians deserve tools that are designed for flying the plane of medicine.
Q: When you were working as a doctor, how did the transformation to creating these tools take place? Was there an aha moment?
A: I had an underserved area commitment to New York State following medical school, and I practiced in a rural county where I was the only dermatologist for 60,000 people in a very close-knit rural county where (there were) lots of primary care docs. And I noticed right away that it wasn't that the primary care doctors were missing really rare dermatologic disease, they were often missing very common diseases. And what happens in medicine is, doctors say common things happen commonly, right? And if you hear hoofbeats, think horses, not zebras, right? Don't think of the rare thing first. Research really shows that diagnostic delay and diagnostic errors, risks to patients, happens more commonly around variation of the common diagnoses, rather than missing rare diseases. So, patients often don't come in like the textbook. … That was my aha moment -- that variation and presentation is causing a lot of harm, and as in a memory-based educational system, we teach the classics. We can't teach every variant, and we expect the students when they become residents, and then doctors, to be able to generalize from that teaching of the classic and that's not easy.
Q: With all the misinformation out there, a patient can go on Google, do a search and self-diagnose. Sometimes they go down a completely different road and confuse the situation, so how do you take back the reigns and build that trust with patients?
A: (A segment of patients are) just going to urgent care, or they go into the emergency department, where the busy clinician is looking through a keyhole at a life. How can a clinician really know the full richness of your problems through a keyhole? I mean there's so much pressure on these clinicians and then when the clinician only spends a minute or two and doesn't really listen, well, there's a real loss of trust.
That patient now who's on Google, who spends two hours before the visit, then sees that generalists just spend one minute with them, that's going to be a voltage drop, a severe voltage drop, but when that clinician says, ‘You know, I'm not sure, let's look that up together and see if your concern about the statin I just prescribed to you for your high cholesterol is causing that other symptom. Let's check that together in this professional tool.’ They do that in 30 seconds, and the patient now sees the doctor responding like, ‘Let's check that together, I have a professional database to make sure that the drugs are not causing your symptom.’ And then that builds trust, because now the patient has seen and listened to this doctor show a caring (attitude). … So you spend that 15 seconds, (showing) how you came to the conclusion, and it will save you 20 minutes of the patient arguing with you.
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The MGMA Business Solutions podcasts are produced by Daniel Williams, Rob Ketcham, Camille Burch and Decklan McGee.
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