Q&A: Figure 1’s Josh Wildstein

A digital healthcare startup improves information sharing among physicians and goes global fast.

Figure 1's photo-sharing app for international medical professionals, which recently raised US$10 million in Series B funding, is taking Latin America by storm.
Figure 1's photo-sharing app for international medical professionals, which recently raised US$10 million in Series B funding, is taking Latin America by storm. Photo courtesy of Josh Wildstein

Figure 1, a Toronto-based photo-sharing app for international medical personnel, is now available across 190 countries. The app allows healthcare professionals to upload photos of medical cases to physicians and other healthcare experts anywhere in the world for opinions and advice. Figure 1 recently raised US$10 million in Series B funding after launching nearly four years ago, including from Samsung NEXT.

Global HealthCare Insights asked Josh Wildstein, Figure 1’s vice president of Business Development and Strategy, about the company’s decisions and strategies behind recent expansion into greater international markets and why Latin America is a top target.

 

Where did the idea for Figure 1 come from?

It came from a critical-care physician who was doing a fellowship in Stanford. He saw his colleagues were taking photos with their iPhones of patient cases and texting them to each other. He thought it was a good idea  but not safe and secure. He and his colleagues decided to focus on an app to allow healthcare professionals of any kind to collaborate on patient cases and talk to some of the best specialists in the world.

 

What is the company’s international vision?

The mission of the company is to democratize medical knowledge. If you have a medical problem and you happen to live in rural China, a physician there should have access to the same information as the world’s best specialist in midtown Manhattan. The app sets out to try and level the playing field by allowing folks through smartphone technology to be able to talk about and share cases, educate each other, and give and get help from each other.

Much of that mission is focused on the international markets and helping folks who may not have the same level of information or educational background, or a general doctor treating a large population in a rural area who doesn’t know as much as a specialist.

 

How has the app grown internationally?

The app was initially launched in English in the iTunes store and focused on the North American market: the U.S. and Canada. It grew rapidly and proliferated into other English-speaking countries, like the U.K., Australia and New Zealand. But then we started to see a lot of uptake from physicians who speak English although not in their native language  in other parts of the world.

Now people are engaging with our app in 190 countries, including in regions where English is not commonly spoken, such as Asia, Eastern Europe and Africa. All these folks have a strong thirst for medical knowledge. Because the app is very visual, if their English is merely so-so, there’s a lot of value to be extracted just from looking at images.

The app is especially appealing to younger physicians and we’ve seen a huge global push from medical students. If you’re a medical student, you just need to see tons of cases. We have 20,000 medical students in Brazil, 18,000 in Mexico, and many more all over the world. We also have 75 percent of all the U.S. medical students.

 

How have you tailored the app for parts of the Latin American market?

We’ve created 2 localized versions  one for users in Brazil in Brazilian Portuguese and another version in Spanish. Localizing, in response to organic growth that was already there, has helped drive growth in these markets. Users can toggle between languages to see just Brazilian cases and even if they don’t speak English, they can still access all other cases all over the world.

Brazil was growing rapidly just with the general English version. Once we localized it, it really took off. Now it’s our second or third largest market internationally, because of its size and the region’s thirst for knowledge. We’ve found physicians in Latin America are even more likely to share cases on a regular basis compared to other groups. We want to pick languages with the most reach where we can have a big impact. The French market is next on our list, specifically because of the Caribbean countries and Africa.

Our theory is that while the product demonstrates a core set of values to users worldwide because we’ve seen international growth, the more local we can make it in terms of language, the better the quality and patient outcomes since communications are in native languages. The more native we make the app, the more quality content it will showcase. This way, if there’s a really complicated case, you can easily share it with everyone all over the world.

 

How does the “paging” feature work?

If you’re a primary care physician with a dermatology case you’ve simply never seen before, you can upload it and then ask to page a dermatologist. A push notification is then sent to the smartphone of every opted-in dermatologist all over the world that says, “I don’t have access to a dermatologist. Can someone tell me what you think is going on?”

Anybody can reply, but the answers of the paged specialists  who are experts on these cases  go to the top. Then everyone else can comment with very specific instructions that may be based on the original poster’s limitations, such as a lack of specific kind of medical equipment. Then several dermatologists may come in and say, “Yes, I’ve seen this. It’s pretty common in this part of the world.” It’s not a firm diagnosis, but a quick consult from experts.

Paged cases receive an answer within 45 minutes. Not only is that fast if you’re sitting in a hospital in New York City, but if you’re in a rural part of the world — where it may take a day or two for a dermatologist to arrive — that’s an incredible thing. Doctors’ refugee camps in Syria have had cases answered from doctors in Vancouver. We had a nurse in Haiti dealing with something life-threatening and 16,000 people all came in to help. It’s an amazing example of how you can seamlessly and quickly link up the whole world to get information shared around a very specific problem. With Figure 1, you can see hundreds of cases  including many unusual presentations you may never see in a hospital, textbook or cadaver lab. We saw Zika cases coming in from Brazil way before it was known. We can be on the leading edge of things happening all over the world.

 

Are there any local considerations to patient problems that practitioners elsewhere wouldn't know about?

Absolutely. Healthcare professionals encounter a different range of diseases, treatments and resources based on their location in the world. When physicians work abroad, for example, they often see new conditions they’ve never encountered at home. Dr. Rogy Masri, a North American member of the Figure 1 community, experienced this firsthand while working in a Syrian refugee camp in northern Lebanon. Using Figure 1, he shared a photo of a patient’s wound and connected with a physician who recognized it as leishmaniasis  a condition endemic to that region but uncommon in North America.

By connecting physicians around the world, we’re unlocking the true power of distributed medical knowledge. For example, cases of Zika virus were shared early on our platform by practitioners in Brazil  well before it had become a widespread global health issue. Seeing real-world examples of these cases early on gave the rest of the Figure 1 community an advantage when treating and advising their own patients.

 

Does the app face any key regulatory, privacy or legal challenges? Do you face any resistance from the medical establishment?

Figure 1 was carefully designed to comply with privacy laws around the world. We have millions of healthcare professionals in more than 190 countries, thanks to the respect and acceptance we’ve received from the medical establishment. Now, some of the world’s largest teaching hospitals and medical journals — including BMJ, CDC, and Mount Sinai Health System — use Figure 1 to reach healthcare professionals with teaching information. It’s incredible being able to work with them.

Our platform has clear guidelines that involve de-identifying every case to remove the patient’s private health information. And all cases are individually reviewed and approved by our 24/7 moderation team before they’re made visible to the Figure 1 community.

 

Does the app provide any disclaimers about the diagnoses that are shared?

Figure 1 is a platform for healthcare professionals, not patients. The physicians that share cases on our platform are familiar with how complex the diagnostic process is and know very well it doesn’t involve relying on one single source — whether it be a journal article, a consult at their institution or feedback from a colleague. For any complex case, they would consult a variety of sources and use their own diagnostic reasoning before making their final diagnosis.

 

— Jacqueline DiChiara

Jacqueline DiChiara is an assistant editor at GHCi.

 

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