Introduction and Rationale
General practitioner (GP) practices face ongoing challenges such as demographic shifts, specialist shortages, and uneven urban–rural distribution. Digital solutions—electronic records, telemedicine, health apps, and smart scheduling—promise to mitigate these pressures and improve outpatient care. Yet, unlike inpatient settings, GP practices lack a widely used, psychometrically validated maturity model tailored to their context. This study addresses that gap by developing and validating a questionnaire to measure the digital maturity of GP practices in Germany, with the aim of informing benchmarking, investment decisions, and targeted improvement efforts.
Objectives
The primary objective was to identify empirically valid dimensions of digital maturity in GP practices and to create a reliable instrument for measuring the level of digitalization at the practice level. The guiding research question was: Which dimensions of digital maturity in GP practices can be empirically identified and validated to develop a robust measurement instrument?
Methods Overview
Researchers conducted a cross-sectional online survey of German GPs using a CHERRIES-compliant design and LimeSurvey. The instrument draws on a qualitative precursor that identified six dimensions and 26 subcategories of digital maturity for GP practices. Item development connected theory to practice, adapting items where appropriate (e.g., leveraging the German TAEG questionnaire for staff skills and the System Usability Scale for infrastructure). A panel of experts refined the items, followed by a pretest with 20 participants spanning GPs and digital health specialists.
Sampling and Data Collection
Data were collected between October 2024 and January 2025. A random sample approach via GP associations, research networks, chambers, and social media facilitated recruitment. Participation was voluntary with no incentives. In total, 375 individuals accessed the survey; 201 completed and met data quality criteria for final analysis after cleaning and validity checks.
Questionnaire Structure and Psychometric Analysis
The core instrument comprised 43 items across 6 pages, using a 5-point Likert scale. Following exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), the researchers refined the model to a 6-dimension, 16-item instrument. The six dimensions are:
– effects of digitalization
– participation of practice staff
– maturity of the practice management system
– staff competencies and sense of responsibility
– IT security and data protection
– digitally supported processes
Initial CFA indicated good model fit but some convergent and discriminant validity concerns. Through item pruning and model adjustments, the final instrument achieved acceptable validity and reliability (overall Cronbach’s alpha 0.809; dimensions ranging from 0.717 to 0.871). The study also computed an overall digital maturity score and dimension-specific scores for each practice.
Key Findings
The analysis showed an average overall digital maturity score of 3.77 out of 5 among participating GP practices. IT security and data protection scored highest (mean 4.45), followed by staff competencies and digitally supported processes (means 4.09 and 3.99, respectively). The lowest maturity was observed in the effects of digitalization (mean 3.10). These results highlight both strengths and gaps in current GP digital ecosystems and point to areas for focused investment and support.
Discussion and Implications
This study provides the first psychometrically tested questionnaire tailored to measuring digital maturity in GP practices. The six-dimension structure reflects a balance of organizational, technical, and human factors, aligning with Donabedian-inspired models of structures, processes, and outcomes. The instrument can be used for internal benchmarking, policy-relevant needs assessments, and program evaluations, potentially guiding funding decisions and initiative design for primary care digital transformation.
Limitations and Future Directions
Limitations include a relatively modest sample size and reliance on a single-country, German-language dataset, which may affect generalizability. Some factors were represented by only two indicators, and the same dataset served both EFA and CFA, raising concerns about external validity. Future work should validate the instrument in independent samples, expand the item pool (particularly for understudied dimensions), and consider incorporating additional domains such as interoperability, governance, and strategic management. Expanding the instrument to encompass other outpatient specialties could further enhance its utility.
Practical Takeaways
For GP practices, the questionnaire offers a structured means to assess digitalization status, identify priority areas (e.g., digital-based processes or staff competencies), and benchmark against peers. For policymakers and payers, the instrument provides a standardized, validated way to quantify digital maturity at the practice level and to monitor progress over time, informing targeted support under reform initiatives and funding programs.
Conclusion
The study delivers a scientifically robust, GP-focused questionnaire to measure digital maturity, with demonstrated reliability and validity. It establishes a foundation for ongoing maturity assessments in the outpatient sector and supports evidence-based digital transformation in general practice.
