Toronto’s Figure 1 has been called ‘Instagram for doctors’ and it’s helping medical professionals with the burning question: ‘What do you think is happening to this patient, and how do I treat it?’
A woman showed up several times within the space of a week at the emergency room in Edmonton, complaining of pain in her legs and feet. She exhibited some unusual bruising as well. A number of days earlier she had been hiking in an Amazon rainforest.
Though it was something of a medical mystery to Joshua Landy and the rest of the critical care team up in Alberta, a doctor in Brazil might have taken one look at the woman’s symptoms and known exactly what was wrong with her.
One did figure it out, eventually. With the patient worsening, doctors in two continents finally put their heads together determined that she had stepped in a nest of poisonous caterpillars and desperately needed an antidote.
A vial was sent from Brazil to Edmonton, but it didn’t arrive in time to save the woman’s life.
That incident made Landy think about number of cases where there are multiple problems going on with a patient, but the underlying cause is difficult to see – especially if you’ve never seen it before.
‘This is what we’re supposed to use the internet for’
If there’s any consolation to be drawn from the hiker’s unfortunate demise, it’s that it helped inspire Landy to create Figure 1. Touted as “Instagram, but for doctors,” it’s a tool for sharing images and text descriptions of cases between medical practitioners around the world. It’s helping heathcare providers find answers to their most perplexing questions, and it has probably saved lives.
At the service’s headquarters in an office building in downtown Toronto, the walls – painted bone white, like an old-timey hospital – are plastered with testimonials from the service’s million-plus users.
Figure 1 helped nurse Karey Thigpen and the rest of a medical team in Virginia to come up with a treatment plan for a patient with severe wounds. In rural Peru, physician Hugo Zuniga uses Figure 1 to seek help and advice as he treats an isolated community of 2,000 – and nor does he “feel so alone” now that he has it.
The energetic thirtysomething Landy zooms over to your correspondent on a hoverboard and pulls up a chair. He says instant sharing of images of patients can help save their lives. When it comes to sharing information, “we’re no longer restricted in terms of borders and boundaries,” Landy says.
Landy has more stories, which he will passionately relate if you ask. There’s the one about a nurse at a birthing centre in Haiti who used Figure 1 to identify a newborn’s skin condition. There’s another about a telemedicine doctor who uses Figure 1 to treat fishing communities in Alaska.
More conventional institutional users, meanwhile, include prestigious hospitals and Médecins Sans Frontières.
“This is what the internet is good at,” Landy says. “This is what we’re supposed to use the internet for: Massive distribution and democratization of knowledge.”
(If you’re fond of gawking at gore, take heart: You don’t have to be a medical practitioner to download the free iPhone or Android app for Figure 1. You do have to work in the field, however, if you want to be a verified user or to upload cases.)
PHONE A FRIEND
In 2012, a few years after the episode involving the Edmonton hiker, Landy found himself working alongside medical students at Stanford. He noticed how they were using their smartphones to share case information and images with each other, seeking one another’s help and advice.
Landy recalls thinking: “These [images] are all educational assets, and they’re all being washed away, or sunk to the bottom of somebody’s inbox, when those pictures could be so useful if exposed to the general medical population.”
“We could do something that’s really powerful”
Hospitals and medical centres had been more resistant than other environments to adopting smartphones and web-based technologies. But if that resistance could be overcome, wouldn’t the smartphone become a powerful tool for medicine?
“The young healthcare professional uses their smartphone for everything except their job,” Landy observes. Yet the smartphone has become the natural tool for a number of information-sharing behaviours for much of the population. It simply makes sense. Taking a photo of something and sending it to a colleague is often easier, for example, than trying to describe it in words.
Says Landy: “I thought if we could apply this to the way medicine is practised, we could do something that’s really powerful.”
Landy partnered with developer Richard Penner (formerly with Kobo), and Gregory Levey, who has an MBA and a law degree and teaches communications Ryerson University. The app launched in 2013 and the company says it’s now in the hands of at least a million healthcare professionals around the world.
Landy says usage can be grouped into four “core behaviours”: Users bring up the app to ask other medical professionals for help, or to share something interesting, to use Figure 1 for teaching moments, and to search for archetypal/reference images of particular medical complaints.
Tell the kids this what will happen if they don’t put their smartphones down
He’s quick to add that Figure 1 is not a clinical diagnosis tool. Medical professionals of course continue to exercise their judgment, and make the final decision about how to treat patients.
Ensuring the privacy of patients is a key activity for Figure 1.
Compliance with the privacy laws of hundreds of different jurisdictions makes for headaches for the legal team (South Korea was especially tricky, involving stacks of paperwork). But these headaches have been more or less surmounted: The service is available in 190 countries – essentially everywhere on the planet, aside from a handful of mostly rogue states including North Korea and Syria.
On the day-to-day level, Figure 1 addresses privacy concerns by vetting every post. Any photo or story that could potentially reveal a patient’s identity has to be stopped before it gets into the app. As the staff wryly note, Figure 1 is the only app with a strict no-selfie policy.
“We review every image manually,” Landy says. That’s the job of six people at a desk at headquarters on Richmond Street in Toronto, as well as a few other people scattered across different time zones.
Given its obviously complex operational needs, Figure 1 requires money to run. Who is covering those costs? Angel investors and venture capital, for now. As with popular services like Facebook, Snapchat and Twitter, Figure 1 was launched without a clear idea of how it would one day generate revenues and profits.
But today the company is sussing out potential revenue streams. “We’re learning what kinds of partnerships are feasible, sustainable, which [bring] a real business opportunity,” Landy says.
“We did not go into this thinking about how it was going to be a business. But we did know if we built something meaningful and useful, people would use it – and we wouldn’t have a hard time figuring out how to make it a viable business.”