Germany’s healthcare system is embarking on an innovative journey to enhance communication and decision-making through the introduction of encrypted messaging services, effectively replacing traditional methods such as faxes, phone calls, and voicemails.
Overseen by Germany’s National Digital Health Agency, Gematik, this initiative introduces a secure alternative to popular messaging platforms like WhatsApp. The service, dubbed TI-Messenger, aims to facilitate seamless coordination among patients, healthcare professionals, and insurance companies regarding medical treatment. Initial trials have indicated that TI-Messenger significantly reduces the time medical staff spend on communication, alleviating the burden of repeated phone calls to busy colleagues.
Moreover, TI-Messenger offers a more dependable and auditable solution compared to the fax communications that have long been a staple in hospitals and clinics. With a population of 83 million and approximately 5.7 million healthcare professionals, the potential impact of TI-Messenger is substantial. A significant milestone was reached in July 2025, when a government mandate allowed all German citizens with public health insurance who utilize their insurers’ apps to access TI-Messenger.
Secure communications
Marie Ruddeck, product manager at Gematik, articulates the project’s vision of establishing a messaging protocol tailored for the health sector in Germany. This protocol aims to empower every health institution to communicate securely while maintaining control over their data. “The goal is to give a messaging system to everyone, so everyone can communicate with each other within healthcare,” she explains. “To do that, we want to give every healthcare provider in Germany the opportunity to build their own messaging system.”
Gematik first published the specifications for TI-Messenger in 2021, leveraging the Matrix open network technology standard. This standard is gaining traction among European governments as a sovereign alternative to messaging and collaboration tools provided by major US tech companies. Matrix, which promotes itself as an open protocol for decentralized secure communications, is managed by the non-profit Matrix.org Foundation.
Pharmacists see benefits of messaging
A trial conducted in Hamburg last year demonstrated the potential of TI-Messenger to streamline communication between pharmacists and hospital doctors. Pharmacists, tasked with reviewing patient medications for potential interactions, typically made around ten phone calls daily, each lasting up to half an hour. The trial revealed that, with TI-Messenger, pharmacists reduced their calls to just one per day.
“I would love to see what we develop [with TI-Messenger] and what we learn from our mistakes shared across the borders into other healthcare systems”
Marie Ruddeck, Gematik
Another trial is set to commence next year in Bavaria, at a university clinic, aiming to connect patients, pharmacists, and doctors through TI-Messenger. The service is available in two versions: TI Messenger ePA, accessible to all German citizens with public health insurance since July 15, 2025, and TI-Messenger Pro, designed for healthcare professionals and insurance companies, which is yet to see widespread adoption. TI-Messenger Pro enables secure messaging, group chats, and document exchanges among health professionals.
Ruddeck notes that while many health insurance companies are already implementing their own messaging services, clinics are beginning to adopt this technology. However, the uptake among doctors has been slower, as their immediate focus has been on implementing the electronic patient folder (ePA), which became mandatory in October for storing electronic patient records.
Chicken and egg
Ruddeck identifies a significant challenge in achieving a critical mass of users on the TI-Messenger network, which is essential for its effectiveness. She describes a “chicken and egg problem,” where potential users hesitate to adopt the app due to a lack of existing users. “We need to persuade people to build clusters. Let’s talk with your pharmacy, your doctor, your care service,” she emphasizes.
Philipp Kurz, founder of Famedly—the first TI-Messenger app approved by Gematik in 2024—suggests that financial incentives for doctors could encourage adoption, alongside simplifying the onboarding process for new users. Ruddeck acknowledges the difficulty large organizations face in changing staff behavior, particularly when clinicians may prefer using unofficial apps like Signal.
While TI-Messenger requires more initial setup compared to standard messaging services, Ruddeck assures that it is user-friendly once operational. She highlights Gematik’s decision to support open-source technology as a significant step forward, stating, “But we managed to do that because we really wanted to use this protocol. It’s state-of-the-art.”
Future vision
Ruddeck envisions a future where Gematik fosters an integrated healthcare system that ensures timely access to the right information. Currently, many medical professionals rely on handwritten notes, which can be illegible and lead to information loss during data entry into computer systems. “We want to be as digitized as possible and to have information where it needs to be, when it is needed,” she states. “We have all the information, but we don’t have the right systems yet to get it everywhere.”
She believes that TI-Messenger can fundamentally alter communication practices, moving away from traditional phone calls and emails. Future advancements may even allow for automated responses or patient triage. At a recent Matrix conference, Ruddeck engaged with representatives from other governments, expressing her hope for collaborative efforts with countries also adopting Matrix-based messaging services, including Norway, Luxembourg, and the Netherlands.
“I would love to see what we develop and what we learn from our mistakes shared across the borders into other healthcare systems,” she adds, hinting at the potential for a European health ID that could connect patients across various healthcare systems in multiple countries.
