Canadian physicians and developers are taking on the controversial world of medical apps.

Since the end of May, two apps in particular have attracted the attention of the health-care community.

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Family physician Dr. Jeffrey Silver is a fan of the Figure 1 app. (David MacIntosh/CBC)

Toronto-area intensive care doctor Joshua Landy is the medical mind behind a new Figure 1 app that was released on May 28. Landy said Figure 1 fills a need, allowing doctors to immediately post, search and comment on photographs while on their iPhones or tablets, much like the popular Instagram app. Limited to verified doctors, it blacks out a patient's distinguishing features and allows physicians to share cases with their colleagues.

Next month, a group of Halifax-based entrepreneurs will launch the social media platform TheRounds that allows doctors to participate in chats from their handheld devices, sharing expertise in a way that mimics the Grand Rounds in hospitals where doctors gather to discuss cases.

But these virtual spaces come with risks, and the health-care industry has historically been cautious about experimentation that can tamper with medical ethics.

"I think doctors are often dragged in kicking and screaming," said Toronto family physician Dr. Jeffrey Silver, an avid fan of the Figure 1 app. "We're one of the last people to adopt these technologies. We still live and die by our phones and fax machines. How many professions can say that? It's a bit embarrassing."

Don't-do lists

The hesitation can be partially linked to a fear of failure in an industry particularly sensitive to mistakes. With doctors bound to vows of confidentiality and discretion, the appropriate way of integrating social media’s culture of sharing is not always obvious.

Organizations like the Canadian Medical Association and the College of Physicians and Surgeons of Ontario have tried to address the uncertainty. Though many hospitals and clinics have policies, the CMA and CPSO have provided guidelines that attempt to find a place for medical ethics in the grey zone that is social media.

"Social media can help support quality patient care, but it also has risks," says Dan Faulkner, the deputy registrar at CPSO. "The internet is public, so doctors do need to be somewhat reflective on what they're posting on the internet."

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Doctors need to be reflective when posting online, says Dan Faulkner. (David MacIntosh/CBC)

Faulkner said the college's guidelines, released at the end of May, are grounded in the existing policies of clinical practice. These include protecting confidentiality of patient information, maintaining boundaries in patient-provider relationships, and conducting oneself with professionalism and respect.

But with all these precautions, many medical professionals say they feel overwhelmed by the list of don'ts.

That's where the Twitter community  #hcsmca (or Health Care Social Media Canada) has stepped in.

Embracing mistakes

Through online discussions as well as periodic "meet-ups" health-care professionals come together to talk about social media's potential and pitfalls. The most recent event, held on June 17 in Toronto, was a panel discussion on failure, something the speakers agreed the Canadian health-care industry is too afraid of.

"You're fooling yourself and your organizations, letting them off the hook, if they don't see that failure is a part of how these things go," said panel host Craig Thompson, the director of digital communications at Women's College Hospital in Toronto.

Fellow panellist Michelle Hamilton-Page agreed, saying the biggest challenge in her attempts to use social media at Toronto's Centre for Addiction and Mental Health were systemic, fighting a risk-averse culture where policy and protocol are rooted in traditional communications channels.

Push from patients

But changes are taking place and Silver said part of that push is coming from patients themselves.

"I think my patients appreciate the fact that we're pretty up to date here," he said. "I haven't had any push-back."

Silver said he always asks permission to take a patient's photo and feels confident in the privacy features integrated into the apps he uses.

"I think confidentiality is a hot button issue in medicine," he said. "No one wants to be used as a case point without giving their consent to do so."

Faulkner said the college hasn't received many complaints about social media but that patients should always feel entitled to ask questions about the information or photographs they put in the hands of their health-care providers.

If patients feel their privacy or rights have been violated, they are encouraged to contact their local college of physicians.

With files from CBC's Melanie Glanz