When the telematics infrastructure (TI) is discussed, the conversation usually turns immediately to obligations, deadlines, certificates, and connectors. This is understandable, as all these Topics are part of everyday life with the TI for many institutions. Yet a more important question tends to get lost in the process: How can access to the shared digital infrastructure of the healthcare sector be designed so that service providers have to deal with the underlying technology as little as possible?
This question is becoming increasingly important. Medical and dental practices, clinics, pharmacies, and care facilities are already connected to the TI. Additional healthcare professions are joining. At the same time, the technical connectivity continues to evolve: with the TI-Gateway, the next stage of development is available as an alternative to the existing connection via a local connector.
This is currently particularly relevant for two groups: practices and facilities that are already connected and facing an upcoming connector or certificate change, as well as healthcare professionals who are connecting to the TI for the first time. Their starting situations differ, but the central question is the same: How can TI access be designed in the future to be reliable and with as little technical effort as possible?
This is more than just a technical change—for both existing and new TI users, the opportunity arises to consider how much technology they actually want to operate on-site themselves in the future.
Many facilities that are already connected are familiar with the principle: A local connector links their systems to the TI. Associated with this are operations, maintenance, updates, and certificates.
When a connector certificate expires, a decision must be made: can the connector certificate potentially be renewed once more, or should the TI connection be set up in a fundamentally different way? The TI-Gateway offers an alternative to the local connector. For practices, pharmacies, and larger facilities, it is therefore worthwhile to consider not only hardware requirements but also operations, scalability, and availability when making this decision.
Switching to a TI-Gateway is not merely a technical decision. Institutions should first consider how their current TI connection is operated and what requirements will exist in the future.
What is decisive includes the existing IT infrastructure, internal responsibilities, number of locations and workstations, as well as the effort required for operation and maintenance. With the TI-Gateway, connector operation shifts from the facility to the provider, while local IT tasks remain. Which model is the better fit therefore depends on the individual starting situation.
Thus, an upcoming certificate change becomes a more strategic decision: Should everything remain as it is for now, or should the transition be made to the next evolutionary stage?
For an economic comparison, it is not enough to compare the purchase price and monthly fees. What matters are the total costs over the planned period of use. Both external costs and internal operational expenditure should be taken into account.
Record one-time costs
Depending on the model, these include hardware, installation, setup, migration, and any necessary adjustments to the network or systems.
Record ongoing costs
Service and operating fees, maintenance, support, and any additional ongoing services should be taken into account.
Consider internal effort
Working hours also incur costs. It should therefore be considered what internal or external effort arises for operations, updates, configuration, troubleshooting, and the coordination of service providers.
Include switching costs
When migrating to the TI gateway, one-time costs may arise, for example for installation. These should not be viewed in isolation, but weighed against the future operational effort.
Consider reimbursements
Which costs of the TI connection are refinanced depends on the respective service provider group and the applicable financing agreements. The regulations applicable to one's own institution should therefore in any case be factored into the calculation.
Not every organization starts from the same point. Decision-makers should therefore first assess their own situation.
Priority 1 – Specific need to switch: Institutions with an upcoming connector or certificate change should evaluate their options first. A concrete decision is required here.
Priority 2 – Initial TI connection: New TI users should clarify requirements, systems, and responsibilities at an early stage so that the appropriate provider can be selected.
Priority 3 – High local IT effort: Facilities that want to simplify their connector operations or have limited IT resources should compare the effort of their existing model with that of a gateway connection.
Priority 4 – Complex structures: Clinics and organisations with multiple sites should in particular evaluate scalability, network architecture, availability, system integration, and centralised operating models.
With the TI-Gateway, the connector infrastructure moves from the facility into the provider's data center. TI-Gateway providers and the components used must meet gematik's requirements and undergo the corresponding approval procedures for this purpose. This includes, among other things, requirements relating to security suitability.
For institutions, however, the central architecture does not mean that security and availability are automatically outsourced in full. The local environment also remains relevant. A VPN connection is required for access; depending on the existing infrastructure, port releases and adjustments to the network configuration may also be necessary. An incorrect firewall configuration, for example, can cause security vulnerabilities or connection problems.
In particular, the guaranteed availability as well as support and recovery times should not be taken for granted, but rather verified on the basis of the specific offering and the agreed service conditions.
A good TI connection should demand as little attention as possible in everyday use. What matters is that the applications are reliably available—not where the connector is located.
Marlene Cieslak, Offering Manager TI-Connect, Deutsche Telekom Healthcare and Security Solutions GmbH
This is exactly where TI-Connect from Telekom and T-Systems comes in: instead of a dedicated connector at the practice or facility, the TI connection is established centrally via the TI-Gateway.
The facility connects to the TI-Gateway in the data center via a secure VPN connection, where centrally operated high-speed connectors are available. Updates, upgrades, and configuration tasks are also carried out centrally.⁴ The local connector hardware and the associated operational and maintenance effort are eliminated.
What initially sounds like a change in technical architecture has a very practical consequence: technology can increasingly recede into the background.
This is particularly relevant for smaller facilities without extensive in-house IT resources; but clinics and larger organizations also need a TI connection that can be operated reliably and scaled to meet different requirements.
A good TI connection should demand as little attention as possible in day-to-day operations. What matters is that the applications are reliably available—not where the connector is located.
A gateway connection should be prepared in good time, especially when the certificate of an existing connector is about to expire. For the transition, gematik outlines five fundamental steps:⁵
Select TI gateway provider
First, an approved provider for the TI gateway is selected. In addition to the scope of services, operational aspects, support, the contract model, and the requirements of the institution itself should also be taken into account.
Register and identify facility
The practice or facility must be registered for access to the gateway. An appropriate proof of identity is required for this. Existing TI identities and their validity periods should also be checked in the process.
Creating technical prerequisites
The provider sets up the gateway access for the facility. In addition, a secure VPN connection to the data center is required. Depending on the existing infrastructure, adjustments to the local network or routing may be necessary. The compatibility of the primary system in use should also be clarified in advance.
Integrating existing components
Existing card terminals may be reconfigured if necessary. Client systems and other local components must be set up so that they can communicate with the TI through the new access point. Here, the gateway provider, the primary system provider, and an onsite service provider can each take on different tasks.
Test function and switch off old connector
Only once the new connection and the required TI applications have been successfully tested will the existing connector be decommissioned. This helps reduce the risk of unnecessary interruptions during ongoing operations.
With the TI-Gateway, operational and data protection responsibility for the central connector shifts to the gateway provider. However, the facility remains responsible for its own local IT environment. Tasks related to the network, primary system, and card terminals may still require collaboration with IT and primary system service providers.
For physiotherapy and occupational therapy practices as well as other providers of remedies and aids, the starting point is different. Many of them are still at the beginning of their engagement with the telematics infrastructure.
For them, there is now a concrete timeline: providers of therapeutic and assistive products must connect to the TI by 1 October 2027.⁶ It is worth not viewing this transition exclusively as a regulatory task. Because with the TI, additional professional groups gain access to the same digital infrastructure from which other players in the healthcare sector are already benefiting.
The TI forms the foundation for various digital applications and processes in the German healthcare system. These include, for example, the electronic patient record (ePA), the e-prescription, and communication in medicine (KIM). As more professional groups are increasingly integrated, the possibility of digitally mapping care processes across sector boundaries also grows.
For new users, this presents an advantage: they do not necessarily have to go through the same technical development as many of the practices that are already connected. Instead of first operating a local connector and later switching to a different architecture, they can start with the TI gateway connection from the outset.
That is why it is worth not waiting until immediately before the mandatory connection deadline to begin planning. Those who engage with TI connectivity at an early stage can clarify what prerequisites exist, which applications will become relevant for their own work, and how access can be meaningfully integrated into existing workflows.
The more interesting question is therefore not just: When do I need to join the TI? But rather: What can I gain from it for my work?
The answer to this varies depending on the facility. The benefits of a TI connection are ultimately not evident in the data center, but where people work every day and organize care.
In a medical practice, TI applications have long been part of many workflows. The focus there is primarily on being able to reliably continue existing processes. When the technical operation of the connection is managed centrally, the practice team has to deal less with connector hardware, updates, or configurations.
For an outpatient nursing service, day-to-day work looks different. Nursing staff work in a decentralized manner and are frequently on the move. Integration into the telematics infrastructure creates the prerequisite for using digital applications and information channels of the healthcare system in this working environment as well.
For a physiotherapy practice, the TI connection can mean gaining access to a digital infrastructure that was previously less accessible. Instead of continuously exchanging information through separate channels, this creates the foundation for becoming more closely integrated into digital care processes in the future.
The examples also illustrate why TI-Connect should not be equated with a single TI application. The solution provides access; which applications are used through it and what specific added value they generate depends on the professional group, institution, and care process.
The telematics infrastructure continues to evolve—and with it, the way institutions gain access to it is changing. The central TI gateway connection already points to an alternative to the decentrally operated connector. For existing TI users, it is therefore worth starting with an inventory: When do the certificates of the existing connectors expire? How much effort is required for operation and maintenance? New user groups, on the other hand, have the opportunity to plan their connection differently from the outset. Those who do not put off engaging with the TI until the last possible moment can clarify technical and organizational requirements early on and familiarize themselves with the TI applications relevant to their own work.
TI-Connect offers an approach for both situations: for facilities looking to restructure their existing TI connectivity, as well as for healthcare professionals becoming part of the telematics infrastructure for the first time. Because in the end, the connector should not be the focus. What matters is what the facility can do with reliable access to the TI.
The TI connection links facilities and service providers to the telematics infrastructure (TI) of the German healthcare system. Through the TI, they can access digital applications and services such as the electronic patient record (ePA), the e-prescription, or communication in medicine (KIM). The connection is established either via an on-site connector or centrally through a TI gateway.
The TI-Gateway enables institutions to access the telematics infrastructure via centrally operated high-speed connectors. This means that no separate connector is required on-site at the practice or institution. Maintenance, updates, and configuration of the connectors are carried out centrally. This reduces the technical effort onsite and simplifies the operation of the TI connection.
No. With TI-Connect, the TI connection is established via the TI gateway. The facility is connected through a secure VPN connection to centrally operated high-speed connectors. A dedicated onsite connector is therefore no longer required. Updates, upgrades, and configuration work on the connectors are also carried out centrally.
An upcoming certificate expiration is a good time to switch the existing TI connection from the on-site connector connection to the TI Gateway.
Yes, for numerous service providers, TI connectivity is already mandatory or will become so in the future. Medical and dental practices, pharmacies, and hospitals already require TI access; for care facilities, the connection requirement has applied since 1 July 2025. Providers of therapeutic and auxiliary services—including physiotherapy, occupational therapy, optics, and hearing acoustics—must connect to the TI by 1 October 2027. The specific requirements and deadlines vary depending on the professional group.
The TI is opening up access to the shared digital infrastructure of the healthcare sector to more and more healthcare professions. This creates the foundation for using TI applications and becoming more integrated into digital care processes. Those who plan their connectivity early can clarify technical and organizational requirements before concrete deadlines limit their room for action.
¹ gematik GmbH: "TI-Gateway – Der neue Weg in die Telematikinfrastruktur", information page on the telematics infrastructure, continuously updated, gematik.de
² gematik GmbH: "Wie wird das TI-Gateway in medizinischen Einrichtungen integriert?", fact check on the telematics infrastructure, May 2023, gematik.de
³ gematik GmbH: "TI-Zugang – Zukunftsfähig und sicher für Primärsysteme, Gateways und Konnektoren", technical information and compatibility overview, continuously updated, specialist portal of gematik, gematik.de
⁴ T-Systems International GmbH: "Telekom startet TI-Connect", company announcement, March 2026, t-systems.com
⁵ gematik GmbH: "Konnektoren: TI-Zugang, Zertifikatsverlängerung, Umstellung", information page and implementation guide for the transition to the TI-Gateway, continuously updated, gematik.de
⁶ Bundesministerium der Justiz / Bundesamt für Justiz: "Sozialgesetzbuch (SGB) Fünftes Buch (V) – Gesetzliche Krankenversicherung, § 360 Elektronische Übermittlung und Verarbeitung vertragsärztlicher elektronischer Verordnungen", legal text, version in force, Gesetze im Internet, bmjv.de
⁷ gematik GmbH: "Zulassungs- und Bestätigungsübersichten – Produkte, Dienste und Anbieter", approval overview of the telematics infrastructure, continuously updated, specialist portal of gematik, gematik.de
⁸ gematik GmbH: "Highspeed-Konnektor (HSK) – Das müssen Sie wissen", technical specialist information on the telematics infrastructure, continuously updated, specialist portal of gematik, gematik.de
