TI-Messenger: Secure and Interoperable
WhatsApp, Signal, and Co. - well-known messenger services that have found a firm place in our private everyday lives. The functions are simple, coherent, and useful, making the services suitable even for those who were not born digital natives. Due to data protection gaps, the use of WhatsApp and other messenger services is prohibited throughout the healthcare industry. After all, special care is required when dealing with sensitive patient data. So how practical would a secure messenger be that could also be used in the healthcare and nursing sector? - The idea is not new, there are already various messengers in use, but they suffer from some weaknesses: interoperable communication is not possible, for the most part, they are not fully DSGVO and DSK compliant, they use different authentication mechanisms and, in addition, they do not have an account migration option. So anyone who switches messengers loses their data unless it has been saved manually beforehand. Politicians thus decided that secure, interoperable TI messengers should be developed for the German healthcare system, which must undergo a certification process at gematik. The legal basis came into force on June 9, 2021, and can be found in the Digital Care and Nursing Modernization Act (DVPMG) and §312 of the German Social Code, Book V, respectively.
Aim and Benefit of the TI-Messenger
The goal of the law is for an interoperable TI messenger to be developed that is based on the Matrix protocol (open source), is end-to-end encrypted, can be freely selected, is location and device independent, and has access to a central directory service. In practice, it could look like this - all healthcare stakeholders can communicate with each other in real-time. For example, it facilitates secure communication for caregivers via a messenger that can also be integrated with primary systems as needed. “Can you check on the patient in room 012 again? She complained of mild back pain an hour ago, and I administered appropriate medications. Currently, I am involved in a family member call, thank you.” A short, yet important message that can make the work of caregivers much easier. To enable secure interaction and protect patient data, secure TI messengers are needed. These are approved in three stages of development. At the end of July, gematik announced the specifications for version 1.1:
In the first expansion stage, the service providers can exchange data such as images or documents and chat with each other across sectors. This is how it was presented in the previous use case. However, this does not have to be limited to one institution - doctors from North to South Germany can exchange information on a specific clinical picture at short notice in chat rooms created specifically for this purpose. This is an important feature where current messenger services reach their limits because they do not have open interfaces.
The next step will be to enable insured persons and health insurers as another user group to communicate using the TI Messenger. The TI Messenger must be accessible to every insured person via the ePA. Patients can then chat with their health insurer or doctor's office directly or via functional accounts, e.g., to make appointments or order follow-up prescriptions. Similar functions have already been tested in doctors' offices, reducing telephone inquiries by around 30%. This is a relief for patients and staff alike.
By the time the third and final stage is reached, all users will have been provided with a messenger. In addition to private and statutory health insurers, institutions such as health authorities or the BfArM can also connect to a TI Messenger. In the final stage, the TI Messenger will be expanded to include a video chat function.
The expectations for the TI Messenger are high, but they should be. After all, it is the first application of the future TI 2.0 and reaches a very large number of users. Other messenger services based on the matrix protocol are currently used by much smaller user groups, such as the Bundeswehr Messenger. On the user side, we are thus talking about a different order of magnitude, because previous applications such as kim+ were used exclusively by healthcare providers. The TI Messenger, on the other hand, is in a different league, as health insurance companies and all those with statutory insurance will benefit from the application in addition to the service providers.
Unnecessary or Overdue?
The answer is clear - a messenger for the German healthcare system that communicates interoperably and securely is overdue. So the question is not whether the messenger will add value but merely when it will become noticeable. We need to catch up here in Germany to be able to ensure high-quality patient care in the future as well. But why are we lagging? - Jan Wemmel, Senior Vice President Health & Public Sector at Arvato Systems, knows: “One of the reasons why we are so far behind in Germany is the sector boundaries. We must finally succeed in overcoming these boundaries. In addition to new payment systems such as hybrid DRGs, the TI Messenger could become another important piece of the puzzle.” To complete the big ‘digitization in healthcare puzzle, the development of the messenger continues to pick up speed with the support of gematik. As the approval process is delayed, the first messengers are expected in the second half of 2023. Insured persons and health insurers should be able to use a TI Messenger from 2024. Millions of people, including physicians, pharmacists, and insured persons, can thus look forward to the following milestones and benefit from the many possibilities, such as the integration of chatbots or AI-controlled devices. The visionaries in the healthcare sector are thinking one step further: interfaces to medical devices are also to be created - in the spirit of a smart hospital. In this way, dialysis machines can communicate with staff in real-time if there are difficulties or problems - directly via push messages to the smartphones of the nursing staff.
Arvato Systems also sees interoperability as an important milestone for the healthcare industry and is actively driving the issue forward with its partners. As a professional in the field of digitization in the German healthcare sector, the company knows the needs of the industry and is rising to the challenge of noticeably improving medical care for patients with the help of digital solutions.
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