The latest mobile app for doctors is Figure 1, which has been touted as ‘instragram for doctors.’  Figure 1 is a crowdsourced medical library that allows individuals to post clinical images from their mobile devices.

The concept makes sense.  Images in medicine represent a great way to teach and tell a story.  But I’m bearish on Figure 1.  Here’s why:

Low barrier to post.  Figure 1 facilitates ease of posting.  Low barrier to entry is good when sharing pictures of you and your buds on the strip in Vegas.  Immediacy and nowness isn’t so good when what we’re sharing requires intent and mindfulness.

Absence of clinical context.  Images offer the best bang for the buck when delivered with some element of history.  Medical images shared in the absence of context run the risk of serving as entertainment.  While it would appear that users can add as much history as they would like, the nature of the application doesn’t lend to this kind of detail.  The platform would create a stronger offering through the encouragement of more background from users.

Risk for sensationalism.  When we share clinical images or stories there’s lots to think about.  Among other things, we need to consider our intent.  Are we sharing to shock, amuse or teach?  I’m concerned that the absence of context coupled with the point-and-shoot functionality creates the potential for shock-and-awe to overshadow show-and-tell.

The world is watching.  While agreeing to the terms of service serves as an acknowledgment that you are a health professional, the system allows you to register as non-professional.  Under that circumstance, you are apparently unable to post or comment to Figure 1.  Makes sense.  But if you try to post as a non-professional, you are prompted to submit for verification as a physician.

I registered and declared myself as a physician and was able to post and comment without ever being verified.  After declaring that you are a physician, there is an option within your profile to become a ‘verified’ physician.  Verified physicians apparently rank higher within the database.

Absence of identification.  Names and institutional affiliations are not part of the registration process and so you can be who you want to be.  Users are identified by user name only.  So while anyone can sign up and call themselves a doctor, it’s practically irrelevant since no one knows who you are.  It should be clear to most who spend time in physician social spaces, anonymity went out of style back in the days of Sermo.

Study the TOS.  The appearance of a walled-off doctor-only community in Figure 1 may lead some to believe that this is a place where we can safely post and share without concern.  But you might make a pot of coffee and hunker down with the terms of service.  The platform is indemnified with dense, eye-opening legalease.  None of this is surprising, really.  But studying the TOS should emphasize how personally accountable and liable physicians really are when they share clinical images.

De-identification is tricky business.  There’s a difference between de-identification of images on a level that’s compliant with health privacy law and de-identification that respects a patient’s wishes.  I operate within the understanding that if a patient can individually identify their own leg, finger, laceration within an image, they should understand very clearly that the image is headed for the very public domain.  Figure 1 recognizes faces and offers tools to erase uniquely identifying characteristics.  The application does take effort to warn users at points along the way.  However, understanding how to de-identify isn’t as straight forward as the application may lead less experienced doctors and trainees to believe.

While there is an in-app consent form that a patient can sign with their finger, I find it hard to believe that any institution, or court for that matter, would recognize such a consent as appropriate or adequate.  And I wonder if that patient in the hospital bed understands that when they consent to the sharing of their image, they “hereby grant to Movable Science, in perpetuity, a non-exclusive, fully paid and royalty-free, transferable, sub-licensable, worldwide license to use the Content that you post on or through the Service, subject to the Service’s Privacy Policy.”

Of course, all of this used to be easy.  In the old days medical images never left the medical library or the glossy paper on which they were printed.  But times have changed, technology is advancing faster than the discussion surrounding its use, and we have to think carefully about how we repurpose and share the images of those under our care.

My criticism has to be tempered with the fact that this concept of photo sharing is ripe for development.  A properly developed tool that cultivates community and thoughtful dialog around medical images has real potential.  I’m afraid that Figure 1 isn’t there with this first iteration.

If I were Figure 1, here’s what I’d do:

• Partner with someone like Doximity to verify physicians.
• Eliminate anonymity.
• Pivot the away from a tool that allows on the fly posting to something that requires more contextual info and forces users to think about why they might be sharing a medical image.
• Tighten the consent requirement in a way that better protects patients.

We’ll follow this to see where it goes.

See also Figure 1 reviews in The Atlantic and MedGadget.