These words of wisdom, paraphrased from a 1984
lecture by the late Lawrence Weed, M.D., a professor of medicine at the University of Vermont (pictured at left), sparked an idea in a young medical student’s mind. That spark led the future doctor to envision and create a clinical decision tool that visually shows, describes, and categorizes thousands of diseases. Used in clinics and medical schools throughout the nation and across the globe, this tool, VisualDx, delivers time-sensitive, clinically relevant information for diagnosing and treating common and rare diseases and brings public health to the point of care.
Art Papier, M.D.’88, was a first-year medical student in Vermont when he attended Dr. Weed’s brown-bag lunch lecture 40 years ago. Papier was fascinated by Weed’s work, which focused on the advantages of keeping detailed, shareable
medical records to improve patient care and health outcomes. Weed devised the now widely used problem-oriented medical record (POMR) to organize patient data by diagnosis and SOAP notes (Subjective, Objective, Assessment, and Plan), a standardized
method for organizing and guiding patient information and thinking. Following Weed’s lecture, the future Dr. Papier began working for Weed’s medical software company, Problem-Knowledge Couplers (PKC), where Papier entered medical literature
information into a data bank for physicians and learners.
“In his small attic office, I was introduced to the problem of cognitive biases in medical decision-making and the limitation of the human mind in handling complexity.
I began to appreciate that individual practitioners could not possibly store every single diagnosis in their heads and—just as important—it was impossible to know all the right questions to ask for each potential complaint the patient
might have,” says Dr. Papier, associate professor in dermatology and medical informatics at the University of Rochester and dermatologist at University of Rochester Medical Center. “With the explosion of medical knowledge,
if we are to deliver high-level care, we need to augment our brains with reliable information as we make decisions.”
This revelation stuck with Papier as he started his residency in 1990 in Rochester, New York, where Kodak—the
photographic film company—was headquartered. The digital photography revolution was beginning, and Kodak had recently designed a system for digitizing Kodachrome slides onto compact discs. By 1999, digital cameras had become ubiquitous,
and Papier was creating prototype digital tools under the company name Logical Images. The product software was released in 2001, but at the time, few people could use it.
“There were no computers in medical exam rooms (to run
the software), no smart phones, and no electronic health records being used (to share the information), so there was little commercial interest in our product,” Papier recalls. “Then 9/11 [terrorist attacks] happened, and Anthrax [deadly
bacterium] was spread in the mail.” These momentous events set VisualDx on trajectory to success, he says.
In November 2001, Papier received a phone call from D.A. Henderson, M.D., M.P.H., a renowned physician who had led the
effort to eradicate smallpox. Dr. Henderson was leading U.S. preparedness to address the threat of intentional dissemination of biological agents, including smallpox. The George W. Bush’s administration intended to mandate smallpox vaccination
for 60 million Americans in six months, with Henderson overseeing the rollout. The smallpox vaccine carried risks that concerned Dr. Henderson, including a potentially fatal complication in people with eczema or the immunocompromised. Henderson
engaged VisualDx to create a website and print materials for the Centers for Disease Control to visually show health care workers normal and adverse reactions to the vaccine.
“We then met with health departments to show how VisualDx could
assist professionals with patients with fever, rash, and possible bioterrorism diseases,” says Papier. “We could give them software they can use daily for common things, and the bioterrorism information will be there if they need it.”
Within two years, health departments in five states and New York City, Los Angeles County, and San Antonio licensed VisualDx, establishing it as a tool in public health preparedness.
Fast forward to 2007 and the proliferation of smartphones
with cameras and internet connectivity. With this new technology, VisualDx returned to its core idea of bringing pattern-recognition skills for any medical problem to the point of care.