cases illustrating value of point of care tools

Lorri Zipperer Lorri at ZPM1.COM
Tue May 7 12:40:21 UTC 2013


From: Art Papier MD [mailto:apapier at] 
Sent: Friday, May 03, 2013 11:22 AM
To: 'Society to Improve Diagnosis in Medicine'; William.Strull at KP.ORG
Subject: RE: checklist vs. checklist - and engaging patients in the


Bill,  We recently received over 100 cases that illustrate how visual
diagnostic CDS can be used in a very practical sense at the point of care.
Many of the cases are about patient engagement.   As you know patients are
intimidated by long diagnostic names they do not recognize.  As it turns out
we all share the innate human ability to pattern match.  One of the reasons
VisualDx is the only diagnostic CDS to be widely used is the representation
of complexity through images.  Here are 3 cases,  I think what these
clinicians are saying illustrates the power of point of care tools.  



Case 1. I currently practice with the Department of public health in Guam.
Since we are located on a rock in the middle of the Pacific, we have limited
access to consultants from many specialties, notably Dermatology.  Another
layer of challenge is that in our practice, English is often the second
language, presenting an additional hurdle in our delivery of understandable
and meaningful information. 


As is often said, "pictures are worth a thousand words", and remains a
reliable method of communication with our multicultural patients.  I have
used the images to assist with diagnosis, but often use as a
teaching/educational tool for my patients.  A recent case where Visual
diagnosis assisted greatly involved my treatment of shingles in a 54yo
female patient.


As in many island communities, local superstitions are entertained when
illness strikes, and can be frightening to the patient.    Having the
ability to review photos of other affected individuals, while offering a
understandable medical explanation for the condition, often confers relief.
They will often bring in other family members to share in the information.
When the patient saw the photos and shared in the review of the information
provided on Visual diagnosis regarding shingles, she was greatly relieved
from a medical as well as a cultural standpoint and her smile was now worth
a 1,000 words as well!    Thank you for your efforts and please know that
your value to providers in more remote areas is immeasurable.


Case 2..I use VisualDx at point of care in the exam room instead of running
back to my office like a Neanderthal & madly flipping thru Fitzpatrick's &
various other derm or rheumatology atlases.

Patients generally prefer to play an active role in the diagnostic process,
& really appreciate observing & participating in use of reliable e-tools
that aid in dx & management.   It's incredibly helpful to show patients
images of another soul with a similar affliction.  It gives them comfort to
witness that this is an understood, well-described entity - not some scary
unknown phenomena - and we've got treatment options....So thank you so much
for developing a fantastic, very practical tool, & keep up the super work
supporting boots-on-ground clinicians who aren't insulated in academia!
-----Family Medicine Physician Eau Claire Wisconsin


Case 3..I saw a patient referred to me to remove a basal cell carcinoma of
his finger. Using visual diagnoses I came to the conclusion that he has a
milkers nodule on his finger as he was raising an calf that needed extra
feeds and medicine and the calf was licking his fingers. I was convinced
that it is a parapox virus infection and that it will resolve by itself
after 6 weeks. It did. Patient was very impressed. Regards EE , MD Emergency
Physician Saskatchewan CA



Art Papier MD

Chief Executive Officer

3445 Winton Place . Suite 240 . Rochester NY 14623 

(585) 427-2790 x230 .  <mailto:apapier at>
apapier at

Logical Images



From: William.Strull at KP.ORG [mailto:William.Strull at KP.ORG] 
Sent: Friday, May 03, 2013 12:27 PM
Subject: Re: checklist vs. checklist - and engaging patients in the


Yes - I agree that our patients can and should be our most powerful partners
in achieving timely and accurate diagnosis.  In addition to the SMART tool
that Bettygene is piloting, and approaches such as Ask Me 3, do others have
specific tools/techniques to better engage patients in the diagnostic

William Strull MD 
Medical Director, Quality and Patient Safety 
Kaiser Permanente 

The Permanente Federation, LLC 
One Kaiser Plaza, 23B 
Oakland, California 94612 
510-271-5987 (office) 
8-423-5987 (tie-line) 
510-271-6642 (fax) 
415-601-6013 (mobile phone) 

Debra C. Costa (assistant) 
debra.c.costa at 

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