Study on digital divide in medical practices: software use with east-west divide

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Even decades after reunification, there are still clear differences in the level of digitalization in German medical practices, according to a study by the Central Institute for Statutory Health Insurance Physician Care (Zi) of the National Association of Statutory Health Insurance Physicians. While politicians are driving forward the digitalization of the healthcare system, many doctors struggle with cumbersome and error-prone software daily. Data from 100,000 practices was analyzed.

“Hot spots” in the West, “cold spots” in the East

The study, which analyzed 39 common practice management systems (PVS), shows that user-friendly systems are mainly found in western German (KV) regions such as Hesse, Schleswig-Holstein, and the North Rhine. In contrast, there is also talk of so-called “cold” “spots”—primarily in the new federal states. In Mecklenburg-Western Pomerania, Brandenburg, and Thuringia, the average satisfaction with the PVS used is significantly lower. This result is consistent with previous Zi analyzes, which have already shown that a lower level of user-friendliness correlates directly with a higher susceptibility to errors, more clicks, and longer processing times—all factors that lead to frustration and inefficiency in the stressful day-to-day practice environment.

The report examines the regional distribution and categorizes the 39 PVSs examined into three groups, but without publishing an explicit ranking of the individual products. The precise assessments of the individual systems have already been published in a previous Zi study (Müller et al., 2024).

However, a glance at the list of analyzed systems shows the enormous diversity of the market: dominant providers such as CompuGroup Medical (with products such as Albis, CGM M1 Pro, Medistar, and Turbomed) and medatixx (including medatixx, x.comfort, and x.isynet) are represented, as are specialized systems (e.g., Elefant, psyprax) and tomedo or T2med. The wide spread of ratings in the preliminary study indicates that user-friendliness is less a question of the manufacturer than of the individual product. Even within the portfolio of a large provider, user satisfaction can vary greatly.

Structural disadvantages make change more difficult

According to the authors, structural and demographic factors in particular play a role in the regional differences—fewer financial resources for practices. “Many practices are still working with software systems that are not very user-friendly, especially in eastern German regions. This could be related to structural disadvantages there, such as a higher workload and the worsening shortage of specialists,” explains Zi CEO Dr. Dominik von Stillfried. The resulting lack of time and lack of information make the often time-consuming change of PVS more difficult.

The age of the medical profession and the proportion of salaried doctors also influence satisfaction, which tends to be lower in the corresponding regions. According to von Stillfried, older practice owners often apply different standards and shy away from the effort of a changeover shortly before retirement. Employees, on the other hand, often have more opportunities for comparison due to their professional mobility but have little influence on the choice of system in the practice. According to a central demand of the study, their perspective must therefore be given greater consideration in the future.

High hurdles to switching systems

The study makes it clear that switching to a PVS is a Herculean task for many practice owners. Long contract terms, high migration costs for data transfer and training, as well as confusing offer structures are massive hurdles. At the same time, the analysis shows that a change almost always leads to greater satisfaction.

This is the decisive lever for policymakers. “If you want to promote digitalization, you shouldn't leave practices to deal with the effort of changing software on their own,” appeals von Stillfried. As the authors of the study emphasize, the user-friendliness of the practice software has a direct impact on the organization, workload, and safety of patient care.

(mack)