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Figure 1
Doctors can share images with other medical professionals and get help on identifying what ails their patients, or teach others about classic cases. Photograph: Figure 1
Doctors can share images with other medical professionals and get help on identifying what ails their patients, or teach others about classic cases. Photograph: Figure 1

Instagram for doctors: how Figure 1 is crowdsourcing diagnoses

This article is more than 8 years old

The medical photo-sharing app lets doctors and medical staff send images of diseases and injuries safely

Where do doctors turn when even they don’t know what’s wrong with you? Colleagues? Books? The internet? A Canadian startup wants to make the answer an Instagram for doctors.

Figure 1 is an app that allows iPhone and Android-owning doctors to share images of diseases, injuries and everything in between. Launched in 2013, the app was born from the idea that sharing images of what confounds doctors with other doctors across the world can help point them in the direction of the right answer.

It’s something doctors were already doing. Over 10,000 texts, WhatsApps and emails with images of curious and classic cases are being sent in the US each day, according to Dr. Joshua Landy, co-founder of Figure 1, who sought to provide a more secure and useful alternative.

“Medicine has always used asynchronous communications such as pagers or phones,” says Landy. “Now we want to help people share images, enabling more eyes on more cases, but with privacy and learning in mind.”

Figure 1 looks like Instagram. Pictures are uploaded into feeds, comments are made and images can be starred – “it’s not a ‘like’, more a bookmark for something to go back to,” says Landy.

Some use their names, others hide behind usernames so colleagues could be collaborating on a diagnosis using the app while unknowingly standing next to each other.

Anyone can join the service and look at the images, but only medical staff – be that doctors, nurses or other medically trained personnel – can become “verified”. In the same way Twitter’s blue tick verifies that a user is who they say they are, Figure 1 will verify someone is a medic by contacting their hospital or a suitable authority database.

The company is verifying 1,000s of doctors a week across 40 countries and at some stage Landy expects to be verifying all users who join, but not at present.

“We’re not after gore seekers, but in some countries such as India reliable databases of doctors are non-existent, so we don’t want to keep them out,” explained Landy.

Doctors post examples of conditions for teaching or to crowdsource answers as a starting point for a diagnosis. Photograph: Figure 1

Uploading images isn’t quite as easy as Instagram. The uploader is required to follow strict guidelines on what is and isn’t permitted. The patient’s face, any text or numbers or identifiable marks should not be in view. Built-in image editing tools can be used to delete any pixels necessary before upload, ensuring patient privacy.

“Uploaded images often look like a mess of black holes where things have been deleted, but that’s fine – this is not about aesthetics, it’s about sharing and learning,” said Landy.

The patient also has to sign a consent form either digitally on screen with their finger or via paper copies. Each consent form is tailored for the country they happen to be patients in and is kept by the doctor, not Figure 1.

Once uploaded, images are queued before being manually reviewed. Those that have identifiable marks, aren’t of educational value, or breach the terms of service are rejected. The images are also stripped of all metadata that could be used to identify the patient.

The image is also owned by the uploader and can be removed at any time, no questions asked.

“Once images are uploaded into the stream, comments and answers start appearing within minutes,” said Landy. “But you can also page people for specific queries.”

Verified doctors can be “paged”, which sends them a notification of a query or picture, asking for their expert opinion.

While Figure 1 has not found widespread adoption in the UK – only one of 10 doctors contacted by the Guardian had even heard of it – those that have started using the app say that it provides a great platform for learning when combined with other tools.

“My main use for Figure 1 is to teach,” said Dr Vikas Shah a consultant radiologist at University Hospitals Leicester. “I upload radiology cases such as x-rays or CT scans with a question or two, and use the commenting feature to teach people about the specific x-ray signs. The reach of the platform means I can teach across timezones, borders, medical specialities and grades.”

The app is popular with medical students and forms part of their adoption of social media and the new smartphone and tablet tools that are increasingly being used in hospitals, according to Shah.

“It is safe to use and there are strict regulations around privacy and anonymity,” he said.

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