New publication in Journal of Medical Systems

Key Message

The choice of hospital information system (HIS) provider is associated with hospitals' digital maturity. Broader module utilization and stronger integration among HIS providers, in particular, are associated with higher digital maturity.

Background

Hospitals worldwide invest heavily in digital infrastructure to improve efficiency, safety, and patient-centeredness. Hospital Information Systems (HIS) form the digital backbone of these efforts. Yet the HIS provider market remains fragmented and heterogeneous, potentially shaping hospitals' ability to achieve digital transformation. The Chair of Health Economics, Policy and Management at the University of St.Gallen examined how HIS provider characteristics relate to the digital maturity of German hospitals.

Methods

The study draws on data from more than 1,600 hospitals (i.e., around 90% of all German acute care hospitals) participating in the nationwide DigitalRadar project (please find further information here). The DigitalRadar score assesses each hospital's digital maturity on a scale from 0 to 100 based on 234 standardized items. Four HIS provider features (i.e., module utilization, integration ratio, external provider variation, and maximum hospital size coverage) were derived and used to group providers into four clusters via k-means clustering. Multivariate linear regressions, controlling for hospital characteristics, quantified associations with digital maturity.

Results and Outlook

Two features proved decisive: HIS providers with broad module utilization (β = 8.18, p < 0.01) and strong integration (β = 12.68, p < 0.01) are consistently associated with higher digital maturity. External provider variation and hospital size are not. The four identified provider clusters reflect this gap clearly: average DigitalRadar scores range from around 41 points in the highest-performing cluster to around 22 points in the lowest-performing cluster. HIS provider choice thus makes a measurable difference to hospitals' digital maturity, though the cross-sectional data reflect associations rather than causal effects.

Implications for Practice & Policy

Hospitals should treat HIS provider selection as a strategic decision, with procurement processes evaluating module utilization, interoperability, and openness to external systems. A full system replacement is often neither operationally nor financially feasible, particularly for smaller hospitals. For these institutions, alternative levers include integration engines, FHIR-based APIs, activating already available but unused modules, and expanding IT staffing capacity. Policymakers can more closely monitor provider-level differences and set targeted incentives for transitions toward providers with broader module utilization and stronger integration.

Publication

Title: Does System Choice Matter? Influence of Hospital Information Systems on Digital Maturity

Authors: Jonas Backes, Alexander Geissler, Jonas Subelack, and David Ehlig

Published in: Journal of Medical Systems

You can read the full study HERE