Limited market readiness and disappointing outcomes—after decades of pilot projects and the unsuccessful electronic health card, strong drivers of progress have emerged in recent years. One catalyst was the COVID-19 pandemic. It accelerated the adoption of technologies such as video-based patient consultations and tele-intensive care support for hospitals outside major urban centers. 

One example is the Virtual Hospital NRW, where specialists at university hospitals in Aachen and Münster supported colleagues in rural hospitals across North Rhine–Westphalia. The objective was to make specialist expertise available in regional settings through tele-intensive care and to support local healthcare delivery.

Another major driver of progress has been regulatory initiatives. In Germany, the Hospital Future Act (Krankenhauszukunftsgesetz, KHZG) in particular has provided significant momentum for digitalization. Federal and state governments are providing a total of EUR 4.3 billion to support the modernization of infrastructure and applications in hospitals. As part of the multi-year funding program, digital maturity is assessed twice using the DigitalRadar evaluation model.

The KHZG approach combines incentives and sanctions. Hospitals that do not invest or fail to demonstrate the expected level of IT implementation by the end of the funding period may face sanctions. These have been announced in the form of reductions of approximately two percent in hospital reimbursement. The German Hospital Federation (DKG) and the National Association of Statutory Health Insurance Funds (GKV-SV) are developing a set of criteria to define the level of implementation at which sanctions will not apply.

Additional drivers of digitalization strengthened by regulatory requirements include:

• the telematics infrastructure for the secure exchange of patient information among healthcare providers
   
• the electronic case transmission agreement (eVV), which governs direct electronic communication between hospitals and the Medical Service
   
• the electronic patient record (ePA)

In addition to the KHZG, other mandatory requirements play a role in digitalization. These include the electronic patient record, which healthcare providers are required to populate with treatment documentation, and the telematics infrastructure, which is intended to enable the secure exchange of patient information between care providers. 

Another obligation arises from the electronic case transmission agreement (eVV). Agreed between the DKG and the GKV-SV, it regulates direct electronic communication between hospitals and the Medical Service (MD), which performs reimbursement reviews on behalf of health insurance funds. In this context, hospitals are required to transmit case-related documentation to the MD in digital form, structured by document types.

For hospitals, such requirements present significant challenges. Document types are often defined differently from one organization to another—for example, what is referred to as a “physician letter” in one hospital may be called a “discharge summary” in another. In addition, the Medical Service applies its own nomenclature.

Artificial intelligence (AI) can support these challenges and represents another important driver of digitalization in healthcare. AI-based technologies can support medical professionals in analyzing large volumes of data and assist with administrative processes. 

Applications are increasingly used in areas such as imaging, patient administration, and information support. In addition, intelligent assistance systems and platforms for structuring unstructured health data create new opportunities to improve efficiency and support consistent information use across healthcare processes.