JMIR Publications

ABSTRACT

Background:

Despite the increasing global impact of digitalization on healthcare systems, Germany initially exhibited a rather slow digital transformation in the healthcare sector. However, recent legislative efforts in Germany intended to accelerate the implementation of digital health applications and communication devices such as electronic patient records, electronic prescriptions and others. In the presented study, we examined practices of information exchange between general practitioners (GPs) and other actors of the healthcare system in a more rural region in Eastern Germany. We aimed to understand the status quo of existing information infrastructures and processes in this transitional phase of digitalization in the health care system and anticipate challenges in the ongoing digital transformation from physicians’ perspectives.

Methods:

The study was set up as a mixed-methods approach combining a survey with GPs residing in the state of Brandenburg in Germany with qualitative interviews with citizens aged 65 and older and general practitioners. The survey aimed at identifying the daily communication efforts GPs and problems in the general and digital exchange were identified. The data were analyzed using the software R (version 4.2.2.). Qualitative interviews investigated the use and challenges of digital applications in ambulatory care. The qualitative data were managed using MAXQDA software (version 22.0.1.) and analyzed using qualitative content analysis according to Kuckartz.

Results:

A total of 250 questionnaires (response rate: 18.5%) and ten qualitative interviews with GPs were included in the analysis. General practitioners primarily still use the telephone, fax or post to exchange information. Newer communication channels that emerged as part of the latest digitalization process of German health care play only a minor role. We identified three intertwined clusters displaying diverse barriers to the digitalization of GPs’ communication practices: 1) incompatibility issues and technical immaturity, 2) lack of knowledge and technical requirements and 3) additional technical, financial and time-related burdens. The analysis revealed that these factors combined can lead to resignation among a certain segment of the GPs’ workforce, especially older physicians. Discussion: The newly established communication channels and applications associated with the current wave of digitalization of the German healthcare system compete with the existing information infrastructure. Many GPs have relied on these established channels for decades, integrating them into their practice routines and care processes. Although newer channels hold potential, they often malfunction and are incompatible with the long-established and highly individualized workflows of GP practices. Resolving these issues and offering careful, step-by-step integration and comprehensive technical support instead of coercive measures appears crucial for increasing GPs' willingness to adopt them. Incorporating healthcare providers' perspectives and ensuring new channels align with established routines can prevent frustration and ensure smooth digital transformation.