Late last year, venture capital megafirm Union Square Partners made an investment that was a bit unusual: They led a $4 million funding round for a startup targeting the medical industry. Figure 1, a small company based in Toronto, attracted Union Square’s attention by creating a social network that allows doctors, nurses, EMTs, and other medical professionals to share medical images.
In a blog post, Union Square’s Fred Wilson said that “Figure 1 takes a popular and effective UI and applies it to an industry in desperate need of change.” In other words: an Instagram-like app dedicated to picture sharing between medical professionals has a market niche.
As of press time, anyone can access Figure 1—though only approved health care professionals and medical students can post to or comment on it—and see a range of content that contains an extensive amount of puzzling injuries and conditions doctors need help diagnosing.
It’s also strangely interesting to an outsider. Figure 1’s main feed was described by journalist John Hermann of The Awl as “an infinite scroll of graphic medical photos—growths, infections, fractures, rashes, traumatic injuries, birth defects,” and the image comments are full of the gallows humor adored by doctors and anyone else dealing with mortality on a daily basis. ER staff show how they improvise when running out of shoe covers for the surgery theater, and debate how Hello Kitty toys get in the stomachs of 4-year-olds.
Joshua Landy, a critical specialist who primarily works with emergency room patients, started Figure 1 in 2013 after seeing, as he put it, “the workflow habits of young physicians with their iPhones.” Having noticed many students in medical school and doctors in residency using their iPhones regularly to share work-related pictures, he and two cofounders began work on the startup in 2013. The app, which is available in 19 countries, now boasts upwards of 150,000 users, with images in the library being viewed on average 1.5 million times a day, according to Figure 1. The company says that 30% of U.S. medical students now use the app.
But there’s a rub: Because Figure 1 deals with medical data, its restrained by a host of privacy laws. Laws like HIPAA in the United States and similar regulations in other countries strictly limit what can and can’t be put online (and how to safely store, encrypt, and protect it) when it comes to medical data. Startups working in the field work with a complicated system of patient waivers that, though ethically right-on, create significant legal and compliance fees other sorts of startups don’t have to deal with.
For Landy, who emphasizes the app’s educational value, ensuring anonymity and privacy has been a concern from the start. Images are posted as either public or private, but all of them must be approved by the site’s medical officer and moderation team to ensure they don’t include identifying features, like names, numbers, or case information. Before images can become publicly available, patients must also give their permission, using an in-app form that doctors share with their patients.
Another company, ReelDx, is well acquainted with HIPAA. Based in Oregon, the two-year-old startup is the YouTube to Figure 1’s Instagram; users (primarily surgeons and other doctors) upload videos of procedures or conditions to ReelDx’s servers. Upon receipt, videos are processed and converted into a common format. These videos are then viewed by medical professionals for education and reference. Although patients aren’t named in the videos, their bodies and faces (in some cases) can been seen, and their voices can be heard in many of them. When encountering interesting cases, medical professionals using ReelDX, as with Figure 1, are required to ask patients to sign waivers allowing them to be documented.
Bill Kelly, ReelDx’s CEO, says the company doesn’t charge to view or upload videos for now, and offers outside developers an API that lets them store and display HIPAA-compliant data within their own apps. The startup is also forming content partnerships with emergency medicine education providers, allowing its videos to be seen by EMTs in training. Before joining ReelDx, Kelly founded online education pioneer Learning.com.
“Having cases on video is superior to simulations and simulation labs set up around medical education,” Kelly explains. “In simulations, the best you can get are actors or dummies which are semi-responsive to the actions of students. In a lot of cases, we heard feedback that people appreciate the value of a real patient case study on video.”
One thing that makes it easier for both companies to acquire content is the simple fact that medical professionals love taking and discussing pictures and video. When I spoke with Kelly, he noted that many doctors tend to avoid more high-tech methods such as iPhones, GoPros, or even Google Glass, instead preferring more conventional point-and-shoot digital cameras switched to video mode. Landy added that quick sharing of visual data among doctors was both commonplace, and that much of his company’s value add was building a taxonomy for the imagery along with an easy and safe (and legal) way of accessing it.
Gone are the days, it seems, when doctors published their photos in low-circulation medical journals: Now patients come in with an unusual, off-putting, or embarrassing condition, and the doctor requests permission to share photo or video of the condition on an app—in the hopes of diagnosing it better, talking about it, even joking about it. It also creates an odd gray zone where patients go into the general practioner’s office or the emergency room and end up with their likenesses (or at least their X-rays) inspiring a publicly accessible message board thread.
Strange, sure. But it’s also an example of how online education works in the post-Internet age. For many nurses, doctors, and EMTs, the existence of a YouTube- or Instagram-derived site that helps them get better at their job is almost second nature. If ReelDx and Figure 1 can figure out how to navigate those waters, it’s a good bet they’ll thrive on a peculiar combination of high-tech medical consultations, social networking and sheer—and, yes, sometimes grotesque—curiosity.