A mobile messenger app as a crowd-sourcing tool for general practitioners - a retrospective observational study

Talk Code: 
Thijs Spanhaak
Thijs Spanhaak, Joost P. Bruggeman, David Schaap
Author institutions: 
Spanhaak: Academic Medical Centre Amsterdam, the Netherlands, Bruggeman: Siilo (www.siilo.com), Schaap: Primary Care Centre "Tolgaarde" (https://huisartsentolgaarde.uwartsonline.nl)


In the UK as well as the Netherlands, 4 out of 10 physicians use mobile apps for instant messaging to ask their colleague for an opinion. Much interest has arisen recently around the use of WhatsApp in the healthcare context despite the fact that such consumer apps have several legal, ethical and regulatory drawbacks. Typically, the academic interest focused on the value that these apps have for hospital care delivery. In this paper, we describe the value of a messenger app as a crowd-sourcing tool for independent general practitioners (GPs).


In the Netherlands, an organically grown group of 200 GPs used the Telegram messenger app to crowd-source, collaborate and educate. The entire group conversation was exported as a PDF. We identified the page where the group reached a size of 200 participants, and took the next 364 days to extract our data. From that conversation, we identified 1064 threads. A thread is defined as a collection of messages regarding a specific topic or question that was initiated by one of the GPs.


Participating GPs were independent practitioners and were aged 34 ± 4 years at the time of the conversation (2015). Fifty GPs (25%) produced 79% of the messages in the year-long conversation. 83% of the GPs initiated a thread. Threads were categorized as (1) case discussions (40% of all threads), (2) update on a previous case discussion (4% of all threads), (3) general medical questions (18% of all threads), (4) guideline/ paper discussions (12% of all threads), (5) practice management advice (25% of all threads), and (6) other (1% of all threads). Case discussions were subdivided in “what-is-the-differential-diagnosis?”-discussions or “what-is-the-treatment?”-discussions or “what’s-the-diagnosis-and-what-is-the-treatment?”-discussions. Response times for case discussions were 12 ± 24 minutes and lasted at average 584 ± 1688 minutes. In comparison, first comments for practice management advice came after 36 ± 100 minutes, and lasted for 428 ± 1645 minutes.


The GPs discussed 3 ± 2 threads per day on average. Although group conversations on messenger apps have neither end nor beginning, the distribution of messages predominately followed office hours. The participating GPs did not experience anxiety or fatigue from the group discussions. In contrast, GPs that did not engage in a thread, experienced the group conversation as valuable, and consumed the discussions on a messenger app as a novel and highly relevant educational platform. In conclusion, a messenger app used as a crowd-sourcing with peers seems to have both utilitarian value for the initiator of the thread, but also educational value for all group participants.

Submitted by: 
Joost Bruggeman
Funding acknowledgement: 
Siilo company has funded the research. Joost Bruggeman is a former surgery resident from the VU Medical Centre in Amsterdam, the Netherlands. He dropped out to start a company, called Siilo. David Schaap is a general practitioner that initiated the Telegram group chat that is the focus of this research and helped shape Siilo's vision. Siilo develops a highly secure messenger for medical professionals worldwide and is currently the secure messenger for Dutch healthcare professionals. Very recently British medical teams started to use the app as well.