Germany's digital radar: a blueprint for national digital maturity strategies?

As part of the German Hospital Future Act (KHZG), which provided over 4 billion Euros in funding to improve the digital infrastructure of the hospitals, the DigitalRadar consortium was commissioned by the Federal Ministry of Health to assess the impact of the financial stimulus. The assignment included the development of a country-specific measurement methodology based on established best practices and aligned with the seven funding dimensions of the government's political goals. Work started in May 2021, and the first round of data collection from 1,624 hospitals was completed in December of the same year – making the DigitalRadar project the largest and fastest digital maturity measurement ever.  Today, the DigitalRadar project is widely recognised as a successful national healthcare transformation initiative. A pioneering project globally, the German government and the DigitalRadar team successfully navigated through the complexities of large-scale change programs and allowed Germany to take a much-needed shortcut toward digital transformation of its healthcare sector. So how did they do it?

1. They established broad multi-stakeholder support to eliminate the risk of political tensions. The DigitalRadar team engaged a multi-stakeholder expert group in the model development. This addressed concerns about the suitability of the developed model and won the support of influential organisations such as the German Hospital Society. The Society, among others, had expressed significant concerns about potentially using US-originated digital maturity models alone, as they believed those do not cover the specifics of Germany's universal health system.
2. Winning the trust of all stakeholders raised acceptance and speeded up the roll-out. The DigitalRadar project, which comprised high-profile organisations and individuals, ensured ongoing alignment and transparent communications with all relevant stakeholders. This included webinars, articles, social media, and personal customer support during data collection. As a result, the reasoning behind the model was well understood, accepted, and swiftly adopted. The data collection process through online self-assessments took only three months to complete.
3. Sensible investment strengthened in-country research and digital autonomy. Germany's "do it yourself" approach proved to be cost-effective, and the total budget breaks down to approx. 3,000 € per hospital, which includes the cost of model and platform development, 2 assessments, the scientific evaluation of the project, various reports, and a longitudinal study. With the new know-how about digital maturity measurement, Germany raised its digital autonomy and is well positioned to further expand the project, i.e., to conduct regular annual assessments or measure other sectors of the health system. The anonymised data is available for research purposes, and the Federal Ministry of Health owns the IP rights of the new development.
4. Incorporating international best practices broadened the scope of the project. DigitalRadar comprised 65% of the HIMSS EMRAM items, which enables basic international benchmarking through an EMRAM indicator score. Although 73% of participating hospitals rated this score as having little to no relevance, it potentially adds an additional layer to the scientific research. Furthermore, it shows German hospitals a path toward international benchmarking if they choose to pursue it in the future.

Results help transform the health system

To prepare its healthcare sector for the future, Germany must implement major policies, including hospital restructuring and determined digitisation of the entire system. In this context, the scientifically validated DigitalRadar date can help guide the change. DigitalRadar showed an average digitisation score of 33.3 out of 100 possible points. Hospitals in Germany perform best in the infrastructure dimension; however, they score lowest in remote services like patient participation and telehealth. Although public hospitals had the highest scores, private hospitals are more advanced in engaging patients and organisational and data management. Hospitals currently spend an average of 2.4% of their operating budget on IT – which compares low to other countries. However, overall, larger hospitals perform better than smaller ones, suggesting that a central organisation, such as hospital chains or alliances, can add the most digital value. This finding aligns with the predictors of the DigitalRadar score, which are the number of hospital beds, the level of broadband expansion, the status of teaching hospitals, and the number of mobile workstations per employee. Most hospitals applied for KHZG funding for digital care and treatment documentation, patient portals, and digital medication management, which is in line with the gaps identified by the measurement. However, funding is not the major obstacle to advancing digitisation. Resistance from clinical personnel due to established work structures and a perceived lack of immediate benefits could hinder digital solutions' implementation. Additionally, interoperability challenges and data protection regulations pose significant obstacles as well. HIMSS mapped the DigitalRadar scores against an EMRAM indicator score and benchmarked it with Canada's Ontario region, the United States, and Australia. This revealed that 96% of German hospitals achieved the very low stage zero or one out of the eight stages of EMRAM, which HIMSS say puts them in a "solid" position in the benchmarking. With DigitalRadar, Germany chose to access international expertise and best practice to create a new digital maturity model. This model considers the specific needs of the country's heterogeneous, well-established hospital sector, as well as the interests of the stakeholders of its universal health system. Like in most European countries, universal healthcare in Germany is ranked among the best in the world. With the DigitalRadar research project, the country underlined its determination to keep it that way in the digital area, too. Armin Scheuer is based in Berlin, Germany, and can be reached at armin@arminscheuer.com and www.arminscheuer.com.