Introduction: Why Measure Digital Maturity in General Practice?
As healthcare systems face demographic shifts, specialist shortages, and uneven GP distribution, digital solutions offer a practical path to maintaining accessible, high-quality care. General practitioners (GPs) are often the first contact in care and serve as gatekeepers coordinating further treatment. This context underscores the need for reliable tools to gauge how well GP practices are digitalizing. A scientifically validated instrument helps practices understand where they stand, benchmark against peers, and identify targeted investments.
To fill the measurement gap, researchers pursued a robust approach grounded in psychometrics and maturity-model thinking. The goal was not only to define digital maturity in GP practices but also to create a practical questionnaire that produces reliable and actionable results.
Methods: Building a Psychometrically Sound Instrument
The study employed a web-based cross-sectional survey of German GPs, guided by the CHERRIES checklist for online surveys. An ethnically diverse recruitment strategy — including GP associations, research networks, and digital outreach — helped assemble a relevant sample. After ethical approval and informed consent, respondents answered 43 items spanning six pages, focusing on six dimensions of digital maturity.
Item development drew on existing instruments and expert input, followed by a pretest with 20 participants to refine content validity and reliability. Data cleaning ensured quality responses, and responses were analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to identify and validate latent dimensions. The study culminated in a six-dimension, 16-item instrument with strong internal consistency.
What Dimensions Define Digital Maturity in GP Practices?
The final model identifies six dimensions that capture the multifaceted nature of digital maturity in outpatient care:
- Effects of digitalization
- Practice culture
- Participation of practice staff
- Maturity of the practice management system
- Staff competencies and sense of responsibility
- IT security and data protection
- Digitally supported processes
These dimensions reflect a blend of structural, processual, and outcome-oriented factors. For example, IT security received the highest maturity score, while the effects of digitalization were rated comparatively lower, highlighting a gap between capability and realized benefits.
Key Findings: Validity, Reliability, and Practical Implications
The validated instrument demonstrated good internal consistency (overall Cronbach’s alpha around 0.81) and acceptable model fit after refinement. Although some convergent and discriminant validity challenges emerged during CFA, the final six-factor, 16-item model offered a robust basis for measuring digital maturity in GP settings. The study also reported an average overall maturity of 3.77 out of 5 in the observed sample, with IT security and data protection scoring highly (4.45/5) and the effects of digitalization scoring lowest (3.10/5).
Practically, the questionnaire serves multiple stakeholders: GPs can benchmark their practice’s digitalization, identify priority investment areas (such as enhancing digital processes or staff competencies), and guide internal discussions. Policymakers and funding bodies gain a standardized, validated tool to assess needs, monitor progress, and evaluate the impact of digitalization programs in outpatient care. For researchers, the instrument offers a foundation for comparative studies and future refinements as new dimensions (e.g., governance or interoperability) are explored.
Limitations and Future directions
Limitations include validation within a German GP sample and the use of the same dataset for exploratory and confirmatory analyses, which may overstate model fit. Future work should seek independent samples, broaden respondent groups (including practice managers or other clinicians), and expand dimensions to cover governance, strategy, and system interoperability. The authors also propose that additional qualitative elements could accompany numerical scores to provide richer, context-specific insights.
Conclusion: Advancing Outpatient Digital Transformation
This study marks the first empirical validation of a GP-specific digital maturity instrument. The 6-dimension, 16-item questionnaire provides a practical, psychometrically sound means to measure digital maturity in GP practices, enabling targeted improvement efforts and benchmarking at the regional and national levels. As outpatient care continues to digitalize, such tools will be essential for guiding efficient investments and ensuring that digital solutions translate into tangible benefits for patients and clinics alike.
