This article is part of our HIMSS 2010 coverage. It includes a brief review of the iPhone medical app from Logial Images – Visual Dx Mobile – and a conversation with Dr. Art Papier, Co-Founder and Chief Scientific Office of Logical Images.

Although an unimaginable array of technology was demonstrated in the hangar-like exhibition spaces at HIMSS, one of the most impressive uses of technology from a physician’s perspective was in a small booth in far off corner. In it, the voluble and passionate co-founder and Chief Scientific Officer of Logical Images (, Dr. Art Papier demonstrated a web and mobile based application that magically produces a sequence of high quality diagnostic images in response to user queries. Since Dr. Papier is Associate Professor of Dermatology at the University of Rochester School of Medicine, the application was originally dedicated to presenting high-quality images of dermatologic conditions.

This is fortunate in two respects. First, the most important findings in dermatology are visible to the naked eye and thus to a camera, second few clinicians (except for dermatologists) have more than the slightest familiarity with dermatologic conditions whereas skin conditions, according to Dr. Papier, account for 15% of visits to PCPs. The application has since also expanded to include radiology. An iPhone and iPod Touch version  was announced at HIMSS this week.

What Visual Logic has pioneered is a sophisticated structured search that allows the physician to sequentially enter more specific information about the patient’s presentation and be presented with a “visual” differential diagnosis. For example, a physician could enter that the patient is a veterinarian, has fevers and has a rash, and with each entry, the panoply of images on the screen would decrease in number until a match is made by the physician. For radiology, a mouse-over the chest xray conveniently highlights the abnormal portions of the lungs on the image. Dr. Papier has also been awarded a $2 million grant from the NIH to create a standardized lexicon for the field of dermatology.

visual dx

The ten-year old web application has over 60,000 medical images collected from physicians and institutions showing that show dermatologic diseases along with their variations with age, stage, and skin color. The more than 100 editors of the collection include some of the distinguished academicians in dermatology, according to Dr. Papier. The textual medical content is obtained from peer-reviewed literature and includes treatment recommendations. There is also a consumer oriented version of the database at In addition to dermatology,  Dr. Papier adds dentistry, endoscopy and pathology as other fields that are amenable to visual diagnosis.


Announced formally at HIMSS is the iPhone version of Visual Logic, appropriately named Visual Dx Mobile, contains over 18,000 images as well as text information such as next steps in management, diagnostic pearls, recommended tests, and ICD-9 codes. In the demonstration of the iPhone app, the image and text display could be seen to be smooth and rapid (see video). One cannot help but marvel at the impressive volume of clinical information now available in a small hand-held device (I wonder if the American Dermatology Association has pondered the implications of launching a small army of amateur dermatologists). The software is generally licensed by institutions but physicians can also buy it as modules, for example the pediatric module would cost $120 per year. According to the company, VisualDx is already in use at more than 1,300 clinical sites, including hospitals, public health organizations, government agencies, medical groups, and medical schools. Current VisualDx subscribers can download VisualDx Mobile for free at Apple’s App Store. Nonsubscribers can request a free trial or purchase a VisualDx subscription in order to access the app.

Dr. Papier emphasizes that the goal is to help physicians make a diagnosis. Much of where health IT intervenes in the clinical process has to do with treatment, such as clinical decision support systems that help physicians select the best or most cost-effective treatment. All of these resources are of little use if the diagnosis is wrong. This is especially relevant the treating physician may not be familiar with the patient’s condition, as is often the case with dermatology.  Even more relevant is that, while every disease has a “classic” or “textbook” presentation, in reality every disease also has innumerable variations. The ER physician, PCP or pediatrician cannot possibly memorize every variation, this is the advantage of specialization and the result of unconscious accrual of pattern recognition. The availability of large atlases is also of limited benefit, since they are invariably organized by diagnosis, which is of little help if you do not already know the diagnosis. With wider availability of sophisticated diagnostic tools such as VisualDx Mobile at the point of care, hopefully more patients can receive quicker and more accurate diagnoses in the future.