Figure 1, already available in the United States, England and Ireland, will be available by the year’s end in Western Europe. It is the newest move for the app, launched in May 2013, that allows physicians to share patient photos. The app hit more than 50 million image views earlier this year.
The Toronto-based developer raised more than $6 million in 2014 for the app. The program, which has more than 150,000 uploaded patient photos, is different than others on the market. UpToDate and DynaMed are two subscription-based image services, but unlike Figure 1, they provide “a highly curated repository” of articles about the conditions, company co-founded Josh Landy told the BBC.
Figure 1 was founded on the principle that the industry needed to move forward and match the social media needs of physicians, particularly medical students. Social media was already being used to share information and photos, but in ways that were not compliant with HIPAA regulations for patient privacy, Landy told Tech Crunch in April. The site reported that there are already users from more than 10% of the nation’s medical schools.
Figure 1 is clearly popular with medical students and physicians, but there are some lingering questions about privacy. Physicians are the only ones able to upload and comment on photos that are posted, but anyone can download the free application.
Patients’ faces are blocked out of photos, but physicians have to cover any potentially identifying markers (like birthmarks or tattoos). Moderators look at each photo before it is put on the site. There is also no medical information or personal data of any patient in the photos, but doctors posting pictures have to post identifying credentials. Only the rarest of conditions are now allowed due to the potential of patient identification.
There are some lingering confidentiality questions left unanswered. Doctors are required to check on consent policies with patients, but what if a patient wants to opt out later? The posting physicians used to be anonymous, but now can be verified through the physician networking service, Doximity. Is identifying a physician enough to identify a patient?
Bryan Vartabedian, a pediatric gastroenterologist at Texas Children’s Hospital and blogger on the intersection of health and technology, voiced concerns on Figure 1, including those dealing with privacy, in a blog post last year. First, Vartabedian said photos without clinical context or history can run the risk of “serving as entertainment.” Not having enough context can risk the chance that photos are being put up to shock or amuse, rather than teach.
Risks to physicians?
Finally, Vartabedian touched on the delicate nature of keeping patient confidentiality. He said a challenge is keeping patients’ identification confidential enough to be compliant with HIPAA versus de-identifying them to respect the patient’s wishes. He said, if a patient can identify their own body parts, they should understand that the image will be posted on social media, even one geared toward physicians.
“The application does take effort to warn users at points along the way,” he said. “However, understanding how to de-identify isn’t as straight forward as the application may lead less experienced doctors and trainees to believe.”