Hi Joost! Can you please introduce yourself and your role?

“I am Joost Bruggeman and I live and work in Amsterdam, The Netherlands, together with my wife, our three boys and our dog. I am the CEO and co-founder of Siilo, the largest secure messenger network in Europe, now being used by around 400,000 healthcare professionals.”

What was it that made you want to work in the digital healthcare industry? 

“I studied medicine and trained to become a surgeon several years ago. In between the two, I also studied for three years at MIT (Massachusetts Institute of Technology), which is where I’m sure I must have been bitten by the entrepreneurial bug! At some point I realised that my zest for entrepreneurship was bigger than my drive to become a surgeon. While I was, and still am, extremely passionate about healthcare, it was the general outlook of working in a highly fragmented and siloed ecosystem – which healthcare is becoming more and more – that just wasn’t very appealing to me. As a result, I believe I took the best of both worlds and became dedicated to improving this ecosystem by creating an app specifically focused on communications between healthcare professionals.”

Tell us about Siilo…

“Since the early days of instant messaging, healthcare professionals have been exchanging clinical data through commercial messenger services, such as Whatsapp and Signal.

“However, these services are not compliant and secure for European healthcare data. With Siilo, we’ve created a digital tool that is safe for them to use, and which sets us apart from our competitors. All data exchanged is fully secured and end-to-end-encrypted. We’ve also developed the app in such a way that it supports everyday clinical collaboration – for example, we’ve added features for case-based discussions.

“Also, after verifying their identity and medical registration, healthcare professionals have access to our entire database of medical professionals throughout Europe to connect, collaborate and educate.”

Can you tell us about the importance of data security and patient confidentiality in healthcare?

“Data security and patient confidentiality are still hard problems to crack in healthcare. Much of that has to do with the complexity of the subject, coupled with the fact that most people simply don’t understand how data leaks happen. For example, there is still a commonly held view that your data is safe because you don’t leave your phone unattended, or because your messaging app claims to have end-to-end encryption. As a result, the importance of using healthcare-specific tools is not yet fully appreciated and, quite honestly, the issue isn’t helped by the fact that most healthcare-specific software isn’t very exciting to use.

“The basic promise of ‘end-to-end’ encryption, which is offered by the best-known messaging apps, certainly provides a strong element of security – it means the servers of the app vendor cannot decrypt the message data, even if they wanted to because they don’t have access to the encryption keys that belong to this encrypted data. But a vendor that claims to have implemented this level of security should also be transparent and willing to be audited on these claims, just like any other software vendor in the healthcare industry. Consumer apps do not allow this.

“In addition, end-to-end encryption only applies to data whilst it is ‘in transit’ from one phone to another. What happens when the data is ‘at rest’, i.e. delivered to a phone or other device?

“After a phone receives a message, several automatic actions take place with common messaging apps: photos and videos sync to the photo library of the phone, where the media is not encrypted; all conversations are backed-up by default onto the cloud services of the phone provider – where message data is also stored unencrypted. As such, all these unencrypted conversations are exposed to unauthorised third parties.

“This is a huge problem because it becomes impossible for any medical professional sending an instant message on most services to be able to guarantee patient confidentiality. To try and get around this, it’s common practice to anonymise patient information within communications, but this can result in healthcare teams being unable to clearly identify which patient they are communicating about and potentially making mistakes, which must be prevented.

“This highlights how ‘off-the-shelf’ messaging apps are simply not suitable for use within healthcare. They offer no guarantee of patient confidentiality, and worse still, they may compromise patient welfare. Reassuringly, in the 18-24 months since the pandemic first took hold, UK adoption of Siilo outpaced the global average by 113% and there are now more than 27,500 Siilo users across the UK’s healthcare sector, suggesting that a change in attitudes is underway.

“While digitalisation offers tremendous benefits to the healthcare sector, it is essential that tools and technologies are truly fit to meet the standards expected. For communications technologies, this means applying absolute rigour to ensure patient confidentiality cannot be compromised.”

You made a career change from resident surgeon to a CEO and co-founder of Siilo, what was that like?

“In healthcare we’re being taught to only rely on tools and processes that have been rigorously investigated, the use of which will only be allowed in the clinical setting once perfected. In software, you actually do something that is quite the opposite: you launch a piece of software that is imperfect in terms of user friendliness (but is perfect in terms of security and compliance of course), and you learn how to quickly iterate and improve the product with user feedback. This concept was initially hard for me to grasp, and very often I see the same struggle with this mindset with medical entrepreneurs. However, once mastered, the approach that software takes in launching and improving, is actually very powerful in terms of breathing innovation into your product.”

Was your medical background necessary for your role at Siilo?

“I strongly believe it was. Traditionally, a lot of digital tools have been created by mathematicians and ICT specialists. At some point I’m convinced they’ll enroll medical specialists or healthcare-related user groups, but it takes them a lot of time to get everything right. Understanding the culture of the profession, the pains and issues that medical professionals deal with on a daily basis really helped us get Siilo off the ground. Care providers trust us because they know we understand what they’re doing.”

What do medical professionals need to understand about digital healthcare?

“It is helpful to recognise the continually expansive role that technology will play in the future of healthcare. A key area where technology can deliver improvements is communication and collaboration. However, it is essential that the tools and services adopted by the sector are fully developed with the healthcare professional in mind. Failure to do so will put patients and their data unnecessarily at risk.

“Technology moves at a rapid pace, so it stands to reason that it frequently advances more quickly than the government and industry can create new standards to address it. However, it is in nobody’s interest to stymie the use of tools which offer huge benefits to the medical profession.”

What has the pandemic taught you about digital healthcare?

“The benefits of digital healthcare were emphasised at the height of the pandemic, when information-sharing and fast decision-making was essential for helping healthcare professionals to learn how to deal with a previously unknown virus. In these circumstances, frontline staff came to appreciate the value of being able to instantly share details about individual patient cases, including photographs and other sensitive medical data. So digital services such as Siilo deliver rapid knowledge sharing that outperforms the classic route of medical publications with orders of magnitude.”

What is next for the digital healthcare sector?

“I hope we will soon drop the “digital” and “electronic” adverbs as we don’t need them to describe where healthcare takes place. Once we do that, we can start to really focus on what is being improved in the lives of our healthcare professionals, rather than who is winning the ‘race’ to digitalization.

“With regard to the ‘next big thing’ for the healthcare sector, I firmly believe we can keep more and more of our patients out of ‘disease’ states, we can keep them closer to their homes and we can create order in the current fragmented, siloed mess that is, in my opinion, healthcare today. Everyone – both professionals and patients – should be able to know quickly where to go for specific experience and expertise. And we hope, in the coming years, that Siilo will play an important role in helping the sector to achieve this.”