On December 7, the Pennsylvania Department of Health announced that the state has deployed a disease identification software system to 45 hospitals - including six hospitals in Pittsburgh, five in Philadelphia and two in Scranton - to help doctors recognize potential exposure to biological agents.

The system, VisualDx, is a database of photographs featuring skin manifestations for nearly 600 diseases. The database consists of more than 10,000 photographs, with typically more than a dozen high- resolution reference images at various stages for each disease. VisualDx serves as a modern alternative to the classic worst-case pictures provided in medical reference texts. In addition to featuring more images than medical textbooks, it serves as an enhanced diagnostic tool by allowing physicians to rapidly narrow in on a differential diagnosis on the basis medical history, foreign travel, and accompanying symptoms.

Such a diagnostic tool could be critical in helping physicians identify patients who have rarely-seen symptoms stemming from a biological attack. "Even the most astute clinician will have difficulty diagnosing a disease they have never seen before," said Dr Art Papier, founder of Logical Images which produces VisualDx.

On November 16, Forbes reported that the New York City Department of Health announced the expansion of its VisualDX pilot program - begun in 2004 - to 25 emergency rooms and clinics throughout the city. VisualDx is also in use in Washington D.C., Mississippi, and by the U.S. Army.