App Lets Healthcare Professionals Crowdsource Patient Cases

July 14--It's been dubbed "Instagram for doctors." With a tap on their smartphones, medical professionals are using a novel app, called Figure 1, to upload photos, X-rays and other images of their patients' maladies. Like Facebook for healthcare, Figure 1 lets colleagues chime in with comments, questions and potential diagnoses.

The mobile app, one of thousands populating the healthcare industry, gives physicians and other healthcare providers instant, pull-it-from-their-pocket access to unusual clinical cases seen by colleagues around the world. It's part of a wave of social media and technology tools that are continually changing the way doctors interact with patients -- and each other.

For the rest of us, it's a glimpse inside the everyday world of doctors and other medical professionals on the front lines of healthcare. Although only licensed medical professionals can upload and comment on the images, anyone can download the app to look at what's been posted.

It's not for the squeamish. X-ray images of foreign objects in a male patient's urethra, unsightly skin lesions and bulging hernias make Figure 1 something you don't necessarily want to peruse while eating lunch.

Launched in May 2013 by Canadian physician Dr. Josh Landy, Figure 1 says it now has users in more than 100 countries, including tens of thousands in California alone.

"It's part of the evolving behavior we're all seeing: using your mobile device to learn ... and expand your expertise," said Landy, 34, an intensive care doctor in Toronto who created the app following a medical research fellowship at Stanford University. Being able to quickly share and discuss real-life cases with one's peers by smartphone "is our way of blending a proven method (of medical education) with modern-day technology."

As a photo-sharing app, Figure 1 also taps into the medical profession's "natural curiosity," Landy said. "Sometimes it's textbook-perfect cases that you're seeing in real life. Sometimes it's just an unusual presentation of common diseases" such as lupus or a heart condition.

Last August, Figure 1 received $4 million in a new round of venture capital funding from New York-based Union Square Ventures. Landy said the company, which has no revenue, is plowing its investment into adding new features and expanding its English-language service into new countries, most recently in India and South America. Under a feature added in April, doctors confronting an unusual new case can electronically "page" their colleagues in the same specialty and confer instantly over possible diagnoses.

"These sorts of approaches where you get assistance from your colleagues is a good way to go," said Dr. Peter Yellowlees, a psychiatrist and professor at UC Davis Medical Center, who wrote a book on medical technology. Doctors, especially in fields such as cardiology, obstetrics or pathology, have long shared photos of unusual cases, but a phone app makes that all the more possible, he noted.

With smartphones becoming "an essential part of (physicians') practices," Yellowlees said he uses his "exclusively" for looking up dosages, side effects and other details on prescription drugs, rather than relying on medical journals or his desktop computer.

Medical apps 'invaluable'

Mobile devices and medical apps "are already invaluable tools" for healthcare practitioners and are expected to become "even more widely incorporated into nearly every aspect of clinical practice," according to a May 2014 study by the National Center for Biotechnology Information. It cited numerous apps that assist with time management, health records maintenance, communications and consulting, patient management and monitoring, clinical decision-making, and medical education and training.

Roughly 150,000 mobile health apps are available in major app stores, according to Research2guidance, a Germany-based research company focused on mobile apps. Some medical mobile apps are free; some are fee-based. Some are geared to patients; others are strictly for the medical community. They vary widely, from MedCalc (a medical calculator) to Doximity (akin to LinkedIn for physicians) to Read (a way to customize articles from medical journals).

Figure 1, which is free, has been especially well received in California, according to the company.

"We've noticed that there's more of an openness to technology in California, so it's been a particularly receptive place," said Annie Williams, Figure 1 spokeswoman, in an email.

Tom Pashalides, a fifth-year urology resident at the UC Davis Medical Center, occasionally looks up photos on the app in his specialty. And although he says he doesn't post photos to Figure 1, he can see the app's appeal.

"It's interesting; there's nothing else like it," said Pashalides, a Sacramento resident. "It's another new technology to connect doctors." But, he noted, without examining a patient and looking at multiple X-rays and photos of a specific case, Figure 1 provides only "a cursory look" at what could be a complicated case.

Although he applauds the ingenuity in inventing a new form of social media for physicians, Pashalides said he would be more inclined to use it if it were peer reviewed or part of published case reports.

For medical school students, apps such as Figure 1 can give them experience beyond the classroom. In San Francisco, UCSF dental school student Neek LaMantia is a regular Figure 1 user "mainly because it takes what you'd see in a textbook into real life."

Now in her final year of dental school, the 24-year-old is one of Figure 1's student ambassadors who use and promote the app among their peers at more than 200 medical and nursing schools in the U.S., Ireland, New Zealand and Australia.

LaMantia, who plans to pursue pediatric dentistry, said she looks up examples from things she's learned in class -- such as facial and jaw reconstruction surgery. But she's also posted examples from her volunteer work, such as before and after photos of a patient she treated last year for severe dental decay at a free clinic in Jamaica.

Aside from clinical images of patients, medical professionals also are using the app to share photos of new technology or clinical techniques in their hospitals or practices, Landy said. Those have included new robotic equipment, IV insertions or unusual surgeries; a recent "Image of the Week" showed the repair of a major heart blood vessel using a patient's smaller veins.

Measles and global diseases

And with the frightening ability of viruses and diseases to spread globally, apps can quickly link healthcare professionals worldwide who come across new or rare conditions. For example, during the recent measles outbreak in California, some doctors were using Figure 1 to look up what measles looks like on patients.

"Because it was previously eradicated in the U.S., they didn't have hands-on experience with it," said Williams. "But in India, it's still very common, so connecting Indian doctors and U.S. doctors around measles is one way that an international community like this can benefit patients and healthcare professionals."

Protecting a patient's anonymity is paramount, according to Landy, who said his first step in creating the app was to meet with healthcare privacy attorneys. Physicians are "100 percent encouraged" to get a patient's permission to use a photo. The app has built-in tools that enable faces and identifying features such as tattoos to be digitally covered up. After a photo is uploaded, it's manually reviewed by Figure 1 employees to be sure the images are appropriate and contain no identifying details.

As long as patient privacy is protected, the increased availability of medical apps such as Figure 1 can be a positive trend, say experts. "It's very patient-centric," said UCD's Yellowlees. "Most doctors are very good at picking up technology when it's useful at a clinical level. There's no question that mobile health is really helping patients get much better care and more accessible care."

Claudia Buck: 916-321-1968, @Claudia_Buck

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