From Mail to Data Space: Healthcare Digitalization with HIN
In the second episode of the HINside podcast, Georg Greve, CEO and Head of Product Development at Vereign, sits down with Peer Hostettler, COO and member of the Executive Board at HIN, to discuss the structural challenges facing healthcare digitalization in Switzerland — and the practical infrastructure being built to address them.
The conversation spans the full arc: from the skilled-worker shortage and investment barriers facing healthcare organizations, through the technical transformation of HIN Mail into a decentralized, swarm-based delivery system, to the emerging architecture for interoperability and self-sovereign identity that will underpin Switzerland’s future health data space. At its core, this is a conversation about how shared infrastructure — built on open standards and digital sovereignty — can do what individual organizations cannot achieve alone.
The original interview is available in German, French, and Italian on the HIN blog.
The full interview
David Umiker: Digital sovereignty is on everyone’s lips these days. Georg, with Vereign you represent an important technology partner of HIN and you have been working on this topic for a long time. What is it all about?
Georg Greve: Yes, digital sovereignty is truly the defining theme of my career. I discovered it in the 1990s and it has not let go of me since. At its core, it is about self-determination in the digital space: open standards, free software, open source. The ability not just to use systems but to understand them and develop them together. Among other things, I contributed by co-founding the Free Software Foundation Europe.
David Umiker: Peer, you are a member of the Executive Board at HIN and have been working in the industry for many years. Where do the biggest challenges in healthcare lie right now?
Peer Hostettler: The shortage of skilled workers is everywhere and no longer affects only physicians — it spans the entire spectrum: nursing, therapeutic professions, and IT as well. The lack of qualified personnel has almost become the norm. An equally central problem is the lack of investment capacity. Many organizations know that they need to invest in digitalization, for example — but they simply cannot. This has a lot to do with existing tariff structures: investments in IT or digital processes often cannot be refinanced.
David Umiker: So more digitalization would be necessary, but is economically difficult to implement?
Peer Hostettler: Exactly. And on top of that, digitalization has not automatically simplified things so far. The original idea was to redesign processes digitally from scratch — to do things differently and better. In healthcare, people first started recording patients electronically, for billing purposes. Then came electronic documentation. And in the end, IT silos emerged in many places. These silos — systems that do not communicate with each other — are what we have today. At the same time, requirements keep rising. So you have to invest: in systems, in interfaces, in security, in processes. That costs real money. And that money simply does not exist in the system. Even tariff changes have done little to change that.
David Umiker: Georg, how do you view this situation from “the outside”? How are healthcare professionals supposed to use digitally sovereign, secure, and modern tools or infrastructure?
Georg Greve: From an IT perspective, healthcare is extremely fascinating. Many challenges are structural in nature: fragmented systems, lack of integration, inefficient processes. But it is not as though there is no money at all. A portion of what currently flows to certain providers — often abroad — could be used differently and more sensibly. The second point is efficiency. If every medical practice starts solving the same problems on its own, that is highly inefficient. The needs are very similar. Not every practice needs its own, completely different email system, for example. That is why, in my view, HIN is so valuable. The basic idea is: as healthcare providers, we pool our resources and solve certain problems together.
Peer Hostettler: Exactly. That is our role: we create an infrastructure that everyone can use, instead of each organization having to invest individually.
David Umiker: That brings us to the core topic of this interview. What role does HIN play in this entire discussion and how did the collaboration between HIN and Vereign come about?
Peer Hostettler: Georg and his team approached us at a moment when we were facing a very specific challenge. We wanted to modernize our HIN Mail service, which also allows third parties such as patients to receive confidential emails. When we looked for an alternative, Georg demonstrated in a proof of concept how encrypted email delivery to non-HIN participants could also work. That convinced us enormously — not just technically, but conceptually. Suddenly the focus was on data minimization, on no longer having centralized data pools, especially for particularly sensitive information. We saw an approach that lifts HIN to a new level of data protection and sovereignty. And one that is also more user-friendly in practice.
David Umiker: What is concretely better about the new HIN Mail?
Georg Greve: When a message is sent, it is first very strongly encrypted and split into many small parts. These parts are stored in a distributed fashion. Only on the recipient’s device are they reassembled, decrypted, and displayed. For the person reading the message, it feels like opening a normal website. But a great deal is happening in the background. The crucial point is: there is no longer any central location where this data exists in its entirety. Not HIN, not Vereign, and no one else can simply access these messages — only the intended recipient. This significantly increases both security and resilience.
David Umiker: As far as I know, HIN Mail was just the beginning. What comes next?
Peer Hostettler: A central topic we are now addressing is interoperability — the ability of different systems to communicate with each other. This is not primarily a data problem, nor simply a problem of missing standards. Above all, it is a trust problem.
Georg Greve: Exactly — it is about the ability of different systems to work together. Today, each practice and each hospital often exists like an island unto itself. But these islands need to be able to talk to each other. That requires secure connections between them. Otherwise healthcare data would flow unprotected. And we need not just any connection, but an “intelligent” one, through which data can flow in an authenticated, traceable, and structured way, so that the next system can automatically take over and process it.
David Umiker: There have already been many attempts in this direction. Why should it work better now?
Georg Greve: Because this topic is a perfect fit for HIN. As Peer said, it is a trust problem. In the past, people often tried to solve such things with centralized technologies. But that always leads to a central point of control. That point can block, fail, or simply be problematic for individual actors because they would have to cede too much control. That is why we need a new structure: more decentralized, more trustworthy, and technically designed so that not everything depends on a single central point.
Peer Hostettler: And with that, the topic of identity takes on a new meaning. The HIN identity has been known for years; it serves healthcare professionals today as a versatile access key. That works very well for people and applications. But when it comes to exchanging structured data between systems, new forms of identification are needed. That is exactly where we come in.
David Umiker: What technology is behind this?
Georg Greve: At its core, we work with decentralized key management and the principles of self-sovereign identity (SSI). The same architectural principle also underlies the future Swiss state e-ID. At HIN, however, we go one level deeper. In a hospital, there are countless systems, services, and in the future also automated processes or perhaps agentic AI components. These need to be able to uniquely identify each other and trust one another. Only then can you make it traceable which system is making which request, whether it is authorized to do so, and what data is exchanged as a result. Without this degree of security and traceability, things become very risky.
Peer Hostettler: And the reason we at HIN can tackle this at all is: we already have a basic infrastructure. It is now being modernized, but it is there. And this renewed foundation forms the basis for precisely these next steps.
David Umiker: How does this relate to national initiatives like a Swiss Health Data Space?
Peer Hostettler: HIN is modernizing its own basic infrastructure and the way services are delivered. Our goal is to make digital sovereignty achievable for every member — for individuals as well as organizations. This happens independently of the federal government. At the same time, we follow programs like DigiSanté very closely and are also in dialogue with them. From my perspective, these programs are primarily about defining rules and frameworks for a future data space. How this will eventually connect concretely with the HIN trust space remains open today.
Georg Greve: We know these questions very well from European data space projects too. There is always a semantic and administrative layer — the question of what a data space should accomplish and represent — and there is the technical reality underneath. What I value about the collaboration with HIN is precisely this pragmatism. HIN starts where concrete added value can already be created today at the technical level.
Peer Hostettler: And added value means, very concretely for us: when a referral is made from a practice today, there are systems that support the process, but in the end a lot of manual effort often remains. Our goal is for such processes to run more simply, more directly, and more sovereignly in the future. That is where the real benefit lies — less unnecessary administrative burden.
David Umiker: To close, the question to both of you: what would need to happen for this development to move faster?
Georg Greve: I would wish for HIN to be understood even more strongly as a competitive advantage for Switzerland. There is already an organization here that can create technical realities very efficiently. This advantage should be leveraged much more and actively promoted.
Peer Hostettler: My wish is different: less regulation. Not in the sense of the Wild West or less security. But the everyday reality in healthcare is already complex enough. If new laws, ordinances, and appendices keep being added, that eventually leads to a blockade. Everyone waits for the next set of rules, the next revision. And in the end, progress falls by the wayside.
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