Sun River Health, a federally qualified health center (FQHC) serving patients across 50 locations in New York State, has started using a solution from VisualDx to strengthen in-house decision-making capabilities and enable more appropriate dermatology referrals. Ken Desa, M.D., chief of virtual and transformative care at Sun River Health, and Art Papier, M.D., CEO and co-founder of VisualDx, recently spoke with Healthcare Innovation about their new partnership. 

VisualDx combines expert medical knowledge, a library of medical images, and AI to support differential diagnosis, identify disease variation, guide treatment, and improve patient communication. It is used by more than half of U.S. medical schools and over 2,300 hospitals and clinics worldwide. Sun River Health’s enterprise-wide deployment includes VisualDx’s full visual clinical decision support platform, including:
• A medical image library to visualize disease across skin tones and patient populations;
• Dynamic differential diagnosis tools to support more accurate, confident clinical decisions; and 
• Integrated patient education resources to improve understanding, adherence, and outcomes.

Papier said VisualDx is seeing an increasing need to support primary care, emergency physicians, and urgent care physicians with dermatology issues. “So many primary care patients will have a visit for asthma or diabetes, and they might say, ‘Doc, what's this on my leg?’ It's a frequent complaint, and it's very difficult to get a dermatology appointment in a timely way. One of the solutions is telemedicine, but there are not enough dermatologists to do all the telemedicine cases. So that's the need we're filling.”

“I would say that the clinical decision support tools available in our current EMR are not super strong in terms of dermatology, which is why we feel this tool was particularly useful for us,” said Desa, a primary care physician.

As an FQHC network, Sun River’s primary aim is to provide services to the underserved, he added. “Many of our patients are uninsured, underinsured, or have limited means. They also have difficulty getting to appointments. If you've got a dermatologist who is 10 miles away, it may as well be 100 miles away. Also, many of our offices are solo providers. We'll have a single provider in the office who may not see a rash that often, or may not have that experience because they're fresh off out of school. The reflex action there would be either to refer them and wait for three months for that appointment, or perhaps to misdiagnose something and not treat it correctly. So tools like VisualDX are great in that they not only are helping diagnose and manage, but also teaching. Because the more you use the tool, and the more you read and learn about the condition, then you can have that patient come back in 10 days and find you actually fixed the problem.”

“We want our tool to have a training effect as you're using it. That’s our North Star at Visual DX,” Papier added. 

Desa added that the tool is so easy to use that Sun River decided to have it open to all clinicians, including nursing teams. “Many times patients will walk in after hours, or perhaps there's only a nurse there. That nurse can upload the photograph, send it off to one of the providers, or even get a good feel for whether this is something that needs immediate attention or whether it's something that can wait.”

Another goal is to cut down on unnecessary referrals. “We’ve got some fairly robust ways of knowing who's referring a lot. We're focusing on those providers to see if we should get them to use the tool first and see what the experience is and see if we can drop their referral rate by using this tool,” Desa said. “That could be a tremendous benefit to the whole system.”

Papier noted that the new federal funding being deployed in states for rural health settings provides another opportunity. “There's such a need in rural America for dermatology,” he said. “There’s a society called the Rural Access to Dermatology Society, and I spoke at their meeting in Denver in March and met with a number of physicians in different states. Now we're working toward letting all these rural states know that VisualDX fulfills this need that can be funded by the rural transformation grants."