Health messengers in Switzerland: what there is to learn from Germany
Germany is further ahead than Switzerland on secure communication in healthcare — and has an expensive failed attempt behind it. Both are instructive; the failure more so.
Anyone in Switzerland discussing secure communication in healthcare points north sooner or later. Germany has a national telematics infrastructure, an agency that runs it, and a messenger built on top. Switzerland has DigiSanté, an architecture study, and a lot of practices making do with a mobile phone.
The obvious conclusion would be to copy Germany. It is wrong, for a reason missing from most accounts: the TI messenger is the second attempt.
The first attempt and why it stalled
Before the messenger came KIM, "Kommunikation im Medizinwesen": a secured message service inside the telematics infrastructure, technically close to encrypted email. KIM works, it is approved, and it meets every confidentiality requirement.
In practices it nonetheless has a poor reputation, and that has little to do with security. Access depends on cards and connectors, setup is laborious, and in daily work the question stands: why should a referral letter take a route that needs three more steps than a phone call? Where the secure option is more cumbersome than the insecure one, the insecure one wins.
A mandate creates access, not use. What gets used is decided by whether the new route is shorter than the old one in the case at hand.
What the second attempt does better
The TI messenger, coordinated by gematik, builds on the Matrix protocol — an open standard for encrypted, decentralised communication. That is the technically most important decision, and it is the right one.
The reason is not the encryption, which any system would have. The reason is that different vendors can build applications that talk to each other. A GP does not need the same app as the pharmacy for both to be in the same conversation. This is exactly where closed platforms fail: they work perfectly as long as everyone uses the same one.
- An open standard allows several vendors instead of one monopolist.
- Decentralised distribution means no single outage brings everything down.
- Extensions such as video or file transfer arrive step by step rather than having to be planned in from the start.
- Changing vendor does not cost you your contacts.
Where Switzerland stands
Switzerland has no mandated channel for communication between providers. It has the electronic patient record, which does something else — it files documents, it is not a conversation channel — and with DigiSanté it has a programme meant to create the groundwork for shared infrastructure. Communication services appear in its architecture work as a possible building block.
That sounds like being behind and is partly an advantage. Switzerland can skip the intermediate step Germany had to take, and does not have to defend an existing infrastructure that has already been paid for.
Three transferable lessons
- 1
Beat the everyday route, not the security level
The benchmark is not the encrypted alternative but WhatsApp. As long as the new channel needs more steps, it loses, and no argument about encryption changes that.
- 2
Build open, not closed
A messenger that only works within one vendor splits healthcare into islands. An open standard lets practice, hospital and pharmacy run different software and still talk to each other.
- 3
Think of patients from the start
In Germany they arrive in a later expansion stage. That creates two systems where one would have done, and the practice runs both in parallel. A channel patients can join without installing anything solves the problem before it arises.
For a single practice the consequence is unspectacular: waiting for a national solution means several more years of phoning and faxing. A channel that works today and has open interfaces is therefore not a contradiction to future infrastructure but the preparation for it.
