5 Ways Health Systems Can Use a Clinical Decision Support Tool to Provide Better Care

Improve the patient experience and help physicians become more efficient and effective using an innovative diagnostic tool.

In an era when physicians are burdened by the complexity of the electronic health record (EHR), adding another tool to their clinical practice mix is sometimes met with resistance. VisualDx appears to be one innovation cutting through the clutter and is used by physicians at health systems because it provides ways for them to perform their jobs more efficiently and effectively, some physicians say.

VisualDx is a clinical decision support system used by more than half of U.S. medical schools and more than 1,700 hospitals and institutions nationwide, including Stanford Health Care, Yale Health, Mayo Clinic, and the entire Veterans Health Administration system, according to Art Papier, MD, co-founder and CEO of the Rochester, New York–based company that developed the tool. It combines clinical search with a medical image library, plus knowledge from medical experts to help with diagnosis, treatment, self-education, and patient communication. The tool can be accessed via an online portal or smartphone.

Among the advantages this solution can offer is to help practitioners arrive at more accurate diagnoses, reduce diagnostic errors, and diminish referrals to specialists. Physicians say it enhances the patient experience, as well as their own, by providing diagnostic guidance in a way EHRs cannot.

HealthLeaders spoke to two health systems who shared their experiences using the system:

• Louis Krenn, MD, is chief medical information officer and family physician at CoxHealth, a six-hospital nonprofit health system based in Springfield, Missouri. VisualDx is used by 75% of its 500+ staff physicians.
   
• Ron Elfenbein, MD, is an emergency physician at Anne Arundel Medical Center in Annapolis, Maryland. This 425-bed nonprofit hospital experiences about 105,000 emergency department visits annually.

HealthLeaders takes a deeper look at this innovation in a separate story, Picture This: A Tech Tool That Helps Physicians Make More Accurate Diagnoses Through Imagery. Following are five ways the health systems are using the tool to provide better healthcare:

1. Keeps Physicians on Top of Current Protocols
 

An abundance of information from multiple sources presents challenges to today's physicians.

"There's a mountain of data that's out there; it's impossible to keep up with," says Krenn. Having reference tools [like VisualDx] allows us, frankly, to provide better care. We don't have to remember every detail of every condition that we've ever studied. You memorize the important pieces and how to recognize things, and then you look it up."

Trying to keep up with evidence-based medicine adds to the challenge, says Krenn. "It's extremely hard, especially in primary care where you have so many different conditions that you take care of, but it's pretty difficult to stay on top of everything. It's just the nature and the expectation of medicine today that you almost can't exist without tools like this."

Elfenbein says he uses VisualDx multiple times daily in the ED to make sure he is operating with the most current information. "For example, today I had a patient that had hospital-acquired pneumonia. I wasn't exactly sure what the first line of antibiotics was [because] the patient had an allergy to penicillin. You go to VisualDx, type it in, and it pops right up."

Even when the emergency physician is certain of a diagnosis, he might glance at the tool's one-page synopsis of recommended treatment for sinusitis, for instance, to ensure he adheres to the latest protocols, he says. 

2. Helps PCPs and ED Docs Diagnose Dermatological Conditions and Reduce Referrals
 

The tool was originally developed to help primary care and emergency room physicians make dermatological diagnoses. While the function of VisualDx has expanded beyond dermatology, it remains a useful resource to physicians.

CoxHealth began using the tool about four years ago when a shortage of dermatologists in southwest Missouri "forced our primary care folks to do more dermatology than perhaps they were comfortable with," says Krenn.

The tool works a number of different ways. The physician can enter symptoms, which will lead to a differential diagnosis, can select images that appear similar to the visual appearance of the presenting patient, or, with a newer version of the tool, can snap a picture of the patient's skin, and the system will suggest a diagnosis.

Krenn says VisualDx has changed the way he practices medicine and has helped build his confidence in making dermatological diagnoses.

"Many times I'll pull [the tool] up while I'm in a room with a patient if I'm not 100% certain of [the diagnosis]," says Krenn. "I'll use it to build a differential diagnosis. It starts to suggest the conditions that you might be dealing with, and you can then click on what you think either matches the closest, or in case of dermatological lesions, you can match it up [to an image]."

Using VisualDx this way helps control the cost of care by reducing referrals to specialists. "We know from multiple repeated studies that referring to specialists costs more money and doesn't always end up with better outcomes," says Krenn. "By taking a few extra seconds [to use] a tool like VisualDx, we can … take care of that patient in the moment rather than having to refer them to a specialist."

3. Improves the Patient Experience
 

Both Krenn and Elfenbein say the tool has changed the way they interact with patients. Patients often search their symptoms or conditions online and arrive in the office or ED convinced they know what's wrong with them, the physicians say. Both doctors agree that sharing images or information on a screen that validates their professional diagnosis is sometimes more convincing to today's patients.

Krenn says the tool engages patients in the process and provides reassurance to the patients that they have been diagnosed correctly. 

Elfenbein agrees. "Patients really love it when you say, 'Hey, do you mind if I whip out my phone and take a picture of your rash and the technology is going to help me.' People think it's really cool, and fascinating, and avant garde, and then it also helps to cement the diagnosis."

4. Offers a Rapid Way to Diagnose Unusual Conditions and Diseases
 

With a location close to Washington, D.C., the emergency department at Anne Arundel sees a lot of patients who travel internationally. The VisualDx system includes options to explore diseases and conditions that could have been picked up in another country, as well as exposure to agents involved in bioterrorism.

"You don't always think about esoteric tropical diseases or diseases that are endemic to [another] part of a world, but the computer program will allow you to do that," says Elfenbein. "You can type in, for example, that the patient was just in Kuwait and it'll give you the diseases that are endemic to [that area]."

The system also helps diagnose unusual conditions and diseases that are not routinely seen in physicians' offices or the ED. Elfenbein used it to diagnose Fournier's gangrene, a rare and dangerous condition involving necrosis of tissue in a patient's perineum. The ED physician's patient had none of the usual risk factors, such as diabetes and obesity. "This person didn't fit the bill, but because I used
[Visual Dx], it helped save somebody's life." 

5. Guides Diagnostic Processes in a Way That EMRs Cannot
 

It's no secret that EMRs have not lived up to their promise and have caused an additional burden for providers. Elfenbein says he believes VisualDx provides the technology that's needed to bridge this gap.

"The EMR was going to be the panacea of medicine," says Elfenbein. "Everybody would know everything. I think that has proven to be utterly false on so many levels. The EMR is basically a glorified spreadsheet and [turns me into] a data entry technician. We enter data and it doesn't help us make a diagnosis in any way, shape, or form."

The ED physician says, "What VisualDx has done is step into that void and brought in the next step computing technology … to help guide your diagnostic process."