The work of general practitioners (GPs) is increasingly characterized by digitalization. Their progress in digitalization can be described by the concept of digital maturity and measured using maturity models. The aim of this scoping review is to provide an overview of the state of research on digital maturity and its measurement in primary care, specifically for GPs. The scoping review was conducted according to Arksey and O’Malley, considering the reporting scheme for PRISMA-ScR. For the literature search, we used PubMed and Google Scholar as the main sources of information. A total of 24 international, mostly Anglo-American studies, were identified. The understanding of digital maturity varied widely. In most studies, it was understood in a highly technical way and associated with the adoption of electronic medical records. More recent, but mostly unpublished, studies have attempted to capture overall digital maturity. So far, the understanding of digital maturity of GPs is still very diffuse—the research literature is still in its infancy. Future research should therefore aim to explore the dimensions of digital maturity of GPs to be able to develop a consistent and validated model for measuring digital maturity.

Background: The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework. Objective: The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice. Methods: An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and Rädiker using MAXQDA software (VERBI GmbH). Results: In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice. Conclusions: The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed.

Background: Digital tools, services, and information in patient care demand new competencies in outpatient care, and the workforce is faced with the need to deal with digitalization. Objective: In a targeted certificate course (Certification of Digitalization Officers in Medical Practices and Psychotherapeutic Practices, Digi-Manager), medical assistants are trained to serve as digitalization officers, enabling them to implement the requirements of digitalized health care within their practices. Methods: As part of an accompanying study, the course is evaluated by the participants, and the change in their digital literacy is recorded. We measured different knowledge, skills, and attitude dimensions at 3 different times—before, during, and after the course—and used ANOVA to examine significant changes. Results: Digi-Managers started the course with an already high self-assessment of their digital literacy. Skills and knowledge increased significantly in all categories (cognitive, technical, ethical, and health information) from the initial to the final measurement, as did self-confidence in the use of general software and hardware. Positive attitude remained stable over the training period, and the course was rated very positively by participants across all areas. Conclusions: Training programs on digital topics for health care professionals are necessary, and this certification course is a role model for successful further education through a mixture of theoretical knowledge transfer and practical application. Especially, the use of a digital maturity model and a digital laboratory was a unique and useful feature. Further research needs to go into alternative assessment methods of digital literacy, as the results suggest that self-assessment measures self-efficacy and confidence, rather than pure competence. Nevertheless, the increase in self-assessed competence suggests that the training was successful.

Background: The digital transformation in health care requires valid instruments to assess the level of digitalization. Maturity models are widely used to measure the digital maturity level of institutions. To date, however, there is no standardized and empirically grounded measurement tool for general practices in outpatient care. Objective: This study aimed to identify and validate the key dimensions of digital maturity in order to develop a questionnaire to measure the digital maturity of general practices. The development of a questionnaire was intended to advance research into maturity models in outpatient care and provide general practitioners (GPs) and policymakers with a tool for the digital transformation process. Methods: A web-based cross-sectional survey study was conducted among GPs in Germany. Based on exploratory factor analysis (EFA), the underlying dimensions of digital maturity were first identified. The factor structure was then examined using confirmatory factor analysis (CFA). After evaluating convergent and discriminant validity, the overall model fit was assessed using fit indices. Following model adjustments based on modification indices, the final questionnaire was established. Finally, we calculated the digital maturity level for our sample, both for each individual dimension and as an overall score, by computing the mean value for each dimension and an overall mean across all dimensions. Results: Responses from 201 GPs were included in the data analysis. We identified and validated 6 dimensions of digital maturity, comprising 16 items. Both convergent and discriminant validity were confirmed. The model fit was excellent (robust comparative fit index [CFI]=0.993; robust Tucker-Lewis index [TLI]=0.990; robust root mean square error of approximation [RMSEA]=0.022; P value of close fit [PCLOSE]=.98; standardized root mean square residual [SRMR]=0.043). The questionnaire included six dimensions: effects of digitalization, participation of practice staff, maturity of the practice management system, staff competencies and sense of responsibility, IT security and data protection, and digitally supported processes. The scale showed good internal consistency (overall Cronbach α=.809). In our sample, the overall digital maturity averaged 3.77 out of 5, with the highest maturity observed in IT security and data protection (mean 4.45, SD 0.61) and the lowest in effects of digitalization (mean 3.1, SD 1.0). Conclusions: This is the first study in which the dimensions of digital maturity in outpatient care for GP practices have been empirically identified and validated as the basis for developing a questionnaire. The findings provide a foundation for further research on measuring digital maturity in outpatient care and for advancing the development of digital maturity models. The questionnaire allows GPs to assess their practices’ digitalization, identify areas for improvement (eg, infrastructure, staff skills), and support internal strategy or benchmarking. For policymakers, it offers a standardized tool to plan support measures and monitor digitalization progress.

BACKGROUND The nationwide rollout of the opt-out electronic health record (abbreviation: eHR; German: Elektronische Patientenakte, abbreviation: ePA) in Germany represents a major digital transformation of the healthcare system. Despite being mandatory for healthcare providers (HCPs) since October 2025 and available by default to nearly 90% of the German population insured under statutory health insurance (SHI), the implementation of the eHR is accompanied by substantial uncertainties. Successful adoption depends on SHI funds as well as HCP and patient engagement, and requires overcoming technical, organizational, and workflow-related barriers. OBJECTIVE The ePA.IMPULS research project aims to systematically identify key facilitators and barriers to the successful implementation, use, and perceived benefits of the eHR. The study evaluates how structured technical and organizational support influences implementation processes, system use, and care-related benefits from the perspectives of HCPs and patients during the national rollout. METHODS The project employs a longitudinal mixed-methods design in terms of a cohort study structured across 4 analytical perspectives (launch, implementation, use & acceptance, and benefit), 2 stakeholder perspectives (HCPs and patients), and 4 time points (t0 – t3). The study builds on a pilot phase (t-1) conducted in a pilot region to test the launch of the German eHR. Practices and hospitals that were part of this pilot phase represent an intervention group receiving intensive support. The control group comprises practices and hospitals that were not part of the pilot phase. Quantitative surveys, qualitative analyses of free-text entries from support or feedback systems, focus groups, and linked administrative claims data will be used to assess implementation challenges, use patterns, and perceived benefits. Data will be analyzed using descriptive and inferential statistics as well as qualitative content analysis. RESULTS The pilot phase (t-1) enabled the establishment of intervention and control groups and generated comprehensive baseline data on technical, organizational, and workflow-related implementation barriers. Retrospective analyses of the pilot-phase (t-1) data have been completed. Subsequent follow-up assessments will compare supported and unsupported HCPs across multiple functional expansions of the eHR (t1 – t3) and integrate patients’ perspectives (t1). CONCLUSIONS ePA.IMPULS prospectively accompanies the nationwide implementation of the eHR in Germany and provides an empirically grounded assessment of real-world implementation processes. By combining quantitative and qualitative evidence across multiple rollout phases and stakeholder perspectives, the project is expected to generate actionable, policy-relevant insights into effective implementation strategies. The findings will inform iterative improvements of the eHR and offer transferable methodological and practical guidance for future large-scale digital health initiatives.