Siilo Messenger: Secure clinical collaboration across teams, networks and boundaries
The popularity of consumer messaging services like WhatsApp among healthcare professionals has been a concern for regulators in recent years – especially in the wake of a series of high-profile patient data breaches.
Clinicians, keen to collaborate with peers both inside and outside their organisations and across disciplines, are scrambling to find a means of communicating easily and quickly, while ensuring data security risks are minimised.
The introduction of the European General Data Protection Regulations in 2018 brought fresh legal and practical implications for the use of mobile messaging services within, and increasingly across, healthcare settings – where care continues to transcend physical and geographic boundaries and clinicians work in teams rather than across shifts. While health leaders recognise that sharing patient information and expertise via smartphone messaging is convenient and – to many – an efficient means to communicate vital information quickly, it needs to be done properly.
Professor Holger Eggebrecht was one of those keenly searching for a tool that ticked all the right boxes and currently serves as a heart specialist at Frankfurt’s CCB Cardiology Centre, a specialist hub for the Rhein-Main region.
‘Around two years ago, I was receiving electrocardiograms (ECGs) and related questions from colleagues every day via WhatsApp. I quickly realised that almost everyone exchanging patient data using that app in Germany would be breaking data privacy rules,’ he explains.
‘My idea was initially to develop my own messenger app to overcome this issue, but when I began researching, I found Siilo Messenger.’
Built-in safety and privacy with Siilo Messenger
Siilo Messenger allows staff within Professor Eggebrecht’s clinical team to quickly discuss sensitive patient cases and make decisions around appropriate treatment options within a sealed environment.
‘Everyone could quickly see the immediate safety benefits,’ Professor Eggebrecht says. ‘For example, the app doesn’t store images in the smartphone’s camera roll and so we’ve been using it as a ‘container solution’ for clinical work and case-based decisions.’
Medical photos and videos are encrypted and stored separately from any personal media held on a user’s device. Any data passed between Siilo users is deleted by default after 30 days, with access to the app itself is protected with a PIN, facial recognition or fingerprint scan.
While emulating the simplicity of WhatsApp, Siilo Messenger also contains a trove of functions and tools tailored for use by clinicians.
Professor Holger Nef, cardiologist and deputy medical director at The University Hospital of Giessen and director of the Heart Centre Rotenburg, explains how his clinical teams are also leveraging Siilo’s features to improve care across their multi-site hospital.
‘We have a weekly board meeting where we discuss our patients. In one of the hospitals, we discuss every patient that will end up in the hybrid operating theatre. In some instances, colleagues may be 100km away and so we discuss these patients in the Siilo group. I’m completely informed about these patients via the app.
‘While it would have also been possible to discuss these cases through WhatsApp, you would not have the option to create these case spaces. This functionality is very important to us.
‘The possibilities we have from Siilo are enormous because we can receive very quick responses from our clinical peers securely from all over the country and benefit from different opinions [on how best to treat patients],’ Nef says.
Siilo – providing swift clinical decision support
To demonstrate Siilo Messenger’s capabilities, Nef outlines how the app can be used during treatment: ‘Our cardiology team contains both surgeons and interventional cardiologists. A member of the team can, for example, upload a mitral valve regurgitation case to the relevant Siilo group. The information will include a medical history and some videos.
‘We can then message the group to discuss whether this particular patient should receive conventional surgery or have an interventional treatment option. This saves a significant amount of time as we have all the information very quickly.’
Nef adds that the increasing need to access information remotely and across teams and networks is a real driving force for the use of Siilo.
‘If you look at where we are now, more and more healthcare professionals drive to work across different sites. But of course, we have to remain connected with our hospital. We have this kind of firewall with the data protection problem, so you cannot enter your hospital’s network from anywhere in the world. But if there is a specific question you need to ask an expert back at base, you can send these questions, videos or lab results, for example, via the Siilo app.’
Eggebrecht explains how Siilo has impacted on his day-to-day clinical work: ‘As a cardiologist, it is essential to the entire department’s success that communication is efficient.
‘My area of medicine is often very demanding and high-pressured, which means the team has to stay alert and focused at all times to ensure everything runs smoothly. Siilo allows us as a team to share and discuss patient cases in a safe way, without the disruptions of personal messaging.
‘For instance, one of our residents on a night shift may have a patient complaining of chest pains and will send them for an ECG. This ECG is then sent to me and it is my job to assess whether or not I need to come in to administer a catheter straight away, or whether it can wait until the morning.
‘If this communication is slow or hindered in any way, it can dramatically affect the patient’s outcomes.’
Sharing best practice within a clinical specialty
Professionals within a range of cardiology sub-specialties are increasingly taking advantage of Siilo to share study findings and patient case studies to continue their professional and clinical development.
Once Nef saw what was possible with Siilo, he decided to try and increase its use among his colleagues across the country.
Nef explains: ‘We also created Siilo groups within our national working group of interventional cardiology (AGIK). We have a working group which consists of more than 1,500 members. Of these members, currently 200 interventional cardiologists are connected within our national Siilo group.’
Nef and his colleagues can easily share pictures, video and journal articles with his peers across the country at the touch of a button.
Besides the ability to effortlessly send text, images, video and documents, Siilo enables easy integration with clinical platforms, allowing users to send files to the app, directly from their workstations.
This means PACS videos, lab test results or medical results can be sent within seconds to a colleague or a group of colleagues with this ‘add to Siilo’ functionality from your computer.
Registration includes a swift validation process, so a user’s peers can be sure that they are exchanging files and messages with certified professionals. In the UK, Siilo Messenger uses General Medical Council registers to verify users’ identities. Helpfully for compliance, Siilo’s data can be wiped remotely if a device is lost or stolen.
Finally, images and PDF files can also be blurred using a simple tool within the app, so that sensitive patient information can be obscured, or anonymised if required before files are sent to a user’s Siilo contact(s).
‘The ease with which you can upload PDFs that you have just read, for example, is a great feature. You can share new information on topics important to our discipline within a second. It’s like Twitter in this respect,’ adds Nef.
Training specialists with Siilo Messenger
Eggebrecht has enjoyed deploying Siilo as a learning and development tool, particularly when training junior colleagues.
‘I use Siilo to send through images of normal ECG tests and then compare them to abnormal EGC tests, to show junior cardiologists what different aspects to look for when identifying a problem. The ability to do this means Siilo offers the possibility to educate not only healthcare professionals within my own practice, but others from different organisations, enhancing patient care on a wide scale.’
Nef agrees: ‘You can educate your trainees and fellows within the department. For example, you can upload pictures which show examples of rare disease, you can post it and then everybody can see how they tend to present.’
A new way of practicing medicine
Professors Nef and Eggebrecht are vocal about the transformative effect that Siilo Messenger has had on both their clinical practice and their professional development.
‘WhatsApp was never intended for use in professional communication. It’s counterintuitive that you’re receiving important patient information that may be life-saving via an app that has a profile picture of someone sitting on a beach on their holiday,’ Eggebrecht explains.
‘There needs to be stronger work/life boundaries and Siilo is one way of encouraging that.’
For Nef, Siilo Messenger is part of a larger shift in the way that healthcare is provided:
‘I think the biggest advantage at the moment is that we have this Twitter-like possibility to post something and get information very quickly from all over the world. I like that.
‘That’s the way we have to look at some aspects of medicine today. ‘There is a specific problem, just tell me your experience and how you would treat this patient’.’
Professor Eggebrecht concludes: ‘Siilo is incredibly trusted among doctors, they believe in it because it represents true improvement in healthcare. They trust a platform that has been designed to support doctors and patients and not to make money on the stock market.
‘I use it every day, several times a day, and communicate with people from Hamburg to Frankfurt to Berlin. It is a real game-changer.’