Hospitals and clinics in Austria are gearing up to replace emails and phone calls with an end-to-end encrypted instant messaging service that promises to speed up communications between medical professionals and reduce the time it takes to make clinical decisions.
The country is conducting trials of a sovereign instant messenger service, based on open source technology, that will allow clinicians to send messages and securely share medical information.
The move follows plans by Germany to roll out its own encrypted messaging service, TI-Messenger, for healthcare, after trials showed that it saved clinicians time by freeing them from making repeated phone calls to speak with colleagues who are often too busy to answer the phone.
The catalyst for Austria to rethink how healthcare organisations communicate came in January 2025 when the government banned the use of faxes to exchange clinical information.
Alternatives to fax
Hospitals developed alternatives, such as encrypted email or encrypted file storage, to share medical data, but the profusion of different tools made it difficult for hospitals to communicate with each other.
Austria’s non-profit body ELGA GmbH, tasked with running the country’s electronic healthcare record system, began investigating alternatives to fax communications before the ban came into force.
In December 2024, it held a workshop on Matrix messenger, an open source encrypted messaging service, and adopted it as a standard a month later.
Matrix, which describes itself as an open protocol for decentralised secure communications, is coordinated by a non-profit community interest company, the Matrix.org Foundation.
Austria chose Matrix because it is decentralised, allowing every state or hospital to run their own server. The protocol allows end-to-end encryption – a requirement for patient data – and is already widely used in Germany and other parts of Europe.
The Matrix side project
One of the first implementations of Matrix in Austria began as a side project by two doctors in Salzburg, who shared a passion for open source software. They set up medSpeak in 2023 to offer a secure communications platform to other doctors in the region.
Phillipp Kurtz, co-founder and joint CEO of Famedly, a German technology company that is now involved in the development of Matrix in Austria, said the doctors were running a Matrix server from their surgery. “They had a little server and set it up themselves and ran all of their other hospitals and their other GPs in Salzburg on that server,” he added. He estimates that between 2,000 and 3,000 doctors have signed up to medSpeak.
That project expanded into a larger trial with the largest healthcare provider in Salzburg, Salzburger Landeskliniken (SALK), and a hospital in the state of Upper Austria, Klinikum Wels-Grieskirche.
The trial, which covered five hospitals, 7,100 staff, and was linked to the MedSpeak network, showed that encrypted messages could be shared successfully between doctors in different Austrian states.
Kurtz told Computer Weekly that the pilot demonstrated the need to build a directory on top of Matrix, to allow medical staff to find each other on the messaging system.
The project used a blueprint for a staff directory developed for TI-Messenger in Germany, and worked to the Fast Healthcare Interoperability Resources (FHIR) specification, a standard for electronically exchanging information.
The trial improved the speed of communication between hospital doctors and GPs. Rather than phone or leave messages, GPs were able to message doctors in the hospital directly to ask questions about medication and care, after their patients were discharged from treatment.
The latest proof of concept, which started in October 2026, has been organised by ELGA, which added Vienna and the federal state of Tyrol to the trial. It will test the ability of Matrix services hosted on different platforms to interoperate with each other.
The proof of concept is supported by three technology suppliers – Famedly, Cloudfight and CompuGroup Medical – which are each running Matrix servers.
Pragmatic approach
Kurtz said he expected Austria to be able to deploy its messaging service quickly, as it takes a more pragmatic approach to technology than Germany. “The requirements for certification are way lower, so you don’t have to certify every single component separately,” he said.
Austria also has an electronic ID system in place, which will make it quicker for doctors to sign up to an existing messaging service hub.
Austrian health organisations can also opt to share Matrix servers, making the service cheaper to run.
“My perception is that they want to have it rolled out, in 2028 at the latest, in the whole of Austria. They really, really want to ramp it up,” said Kurtz.
One-stop shop
Using a shared technology across the Austrian health service will allow clinicians to talk to their counterparts in other healthcare institutions more easily and quickly, said Kurtz.
“You have one shared platform, one shared technology, and as long as you comply with that, you can talk to anyone in the system. So it’s really a one-stop shop for all your communication with other healthcare institutions,” he added.
[With] one shared platform, one shared technology … you can talk to anyone in the system. So it’s really a one-stop shop for all your communication with other healthcare institutions Phillipp Kurtz, Famedly
The service is expected to be particularly valuable when junior doctors working in a hospital need advice from a consultant or a senior doctor waiting at home on call.
“The junior doctor doesn’t know what to do, so he just takes a photo of an ECG or X-ray or whatever and sends it via chat to the doctor on call, who can send a message back without having to come into the hospital,” said Kurtz.
The service is also expected to find applications in nursing homes, making it easier for doctors to communicate with pharmacies when they prescribe medication to residents.
Currently, the process takes multiple phone calls and follow-up faxes, which doctors are required to sign off manually.
In future, Kurtz predicts that Austrian and German hospitals will federate their messaging services to allow doctors in both countries to collaborate.
“Especially in winter, how many Germans go skiing in Austria and break a leg? There are always things to discuss between the German doctors and the Austrian doctors,” said Kurtz.
Managing stakeholders
Kurtz said the biggest challenge has been the need to manage a large number of stakeholders, which include federal states, hospitals, central and federal governments, and doctors using the homegrown medSpeak platform.
“They all want to have a say in it, so bringing all the interests together and coming up with a joint standard … has been crazily complicated with all the stakeholders,” he added.
Another challenge is that hospitals in Austria rely on shared inboxes, representing, for example, a ward where multiple people may be working. This format is not currently supported by Matrix.
“Matrix just simply doesn’t have a good concept for this. This is something that’s missing and making implementation for these use cases extremely hard,” said Kurtz.
The project is improving by using a group chat room that receives all the messages sent to doctors on the ward. The system uses a bot to discuss the request with several staff on the ward to find out which doctor should respond to the enquiry. The doctor can then reply to the message in a new private chat.
Less talk, more action
Matrix will become available to health providers in Austria from 2027, with a number of providers offering servers and messenger apps.
Kurtz said that although medical professionals realise they need to have a system like Matrix, the challenge will be changing their behaviour so they don’t continue to use faxes or WhatsApp.
“The most important leverage we have is the chief of medicine – if they are convinced and they tell their people to use just the Matrix-based solution, they will,” said Kurtz.
Were he to do the project over again, Kurtz said he would be more pragmatic, by talking less with stakeholders and acting more.
“Trial and error gets you to your goal a lot faster than trying to think through all the ways to use Matrix, which we have done in countless discussions, workshops and meetings. I would say, we just start with something basic and see what happens,” he said.
