X-rays and smartphones and Figure1

A few weeks back, Fred Wilson wrote about his investment in Figure1, a social site for doctors to share radiology images - X-rays, MRIs, CTs.

The hypothesis behind Figure1 is that doctors can share images "en masse" across the network, leveraging the knowledge of many doctors to analyze, and benefitting every doctor who submits an image for others to read, or can compare existing images to the one that s/he is looking at this very moment.

The questions that bother me are whether this is necessary, and whether doctors are prepared to adopt it.

Is It Necessary?

Doctors have adopted much of technology with gusto. In the early days of PDAs, doctors carried their entire pharmacology list on their Palm Pilots, reducing their need to remember thousands of drugs, their interactions, and their dosages. These have since moved to smartphones with regular cloud-based updates.

The next generation is mobile imagery. Doctors not only use their smartphones to take images, they use their patients' smartphones to take images and iMessage/WhatsApp to pass them around.

Back in February, I broke my ankle playing ice hockey (adding insult to injury, my team went on to win the tournament without me; I am glad they won, but I would have preferred to play to the end). A friend of mine from the tournament is a first-class orthopedic surgeon, and advised me that under no circumstances should the local emergency room orthopedist be allowed to operate or significantly treat without clearing it with my friend first. How, exactly, was I to have my friend see the images when they were on a hospital computer 20 miles from my friend?

"No problem. Tell the ER doctor to bring them up, snap a picture with your iPhone, and send it to me via iMessage or WhatsApp."

I was surprised, had never heard of this before, but followed his suggestion. Even more surprisingly to me, the ER doctor was entirely used to it, actually expected it when I asked him to bring up the images.

Remote medicine performed entirely by smartphone plus free messaging app.

Will Doctors Adopt It?

Doctors are notorious for being over-confident in their own knowledge. While they will often consult other doctors, they carefully vet those with whom they consult, trusting only to those they personally feel are the "best of the best." This shouldn't surprise us; they are trained for years that they were the smartest, which is how they got into that great med school, let alone survived it, and those smarts are what make them so indispensable to society. While I have known many truly modest doctors, and many truly great doctors, and even a few great but modest doctors, our system still trains them to focus on their own skills and those within their own personal experience network.

A network of thousands or tens of thousands of doctors and images they do not know personally, by referral or by reputation is a foreign construct to most doctors, and one which makes them uncomfortable.

Do doctors who already have iMessage/WhatsApp and smartphones with high-resolution cameras actually need a social network? It clearly has benefits such as widespread sharing and interpretation of images and a broader base of images to compare against. But is it sufficiently better than the basic solution to drive adoption? And will it overcome doctors' aversions to go beyond their own smaller networks?

It is also a liability landmine. If Dr. Smithers does not know the patient, has not seen the patient, has seen an MRI that has no name or history attached to it, determines that a growth is not a concern, and the person dies, will the family sue Dr. Smithers, or just the direct oncologist? Who holds malpractice liability?

Personal bias: since I like Fred, and I want his investments to succeed, I most sincerely hope so.