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Hospital Future Act – “digital update” for hospitals?

At the beginning of October 2021, the Bundesrat and Bundestag passed the Hospital Future Act. Its contents are intended to help the German hospital system address deficits in the digital transformation. The most important contents in this regard are captured in this article.

Hospital Future Act – “digital update” for hospitals?

At the beginning of October 2021, the Bundesrat and Bundestag passed the Hospital Future Act. Its contents are intended to help the German hospital sector to eliminate deficits in the digital transformation. The most important contents in this regard are recorded in this article.

The most important information at a glance:

Die wichtigsten Informationen im Überblick

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Figure 1: KHZG at a glance

Where do hospitals stand today?

Germany’s hospitals lag far behind in an international comparison when it comes to digitization (Baierlein/Quandt 2020). According to a study for the Hospital Report 2019, the Ø EMRAM score (digitization maturity level according to an internationally recognized classification system) in 2017 was 2.3 on a scale of 0 to 7. There is still great potential for development, particularly in smaller hospitals and in hospitals with high economic deficits. One of the main reasons that is repeatedly put forward is the much-discussed investment backlog in German hospitals. Even if we hope that digitization will add a great deal of value to patient care and employee satisfaction, the initial investment costs can be high and must first be justified on the basis of a benefit that is as directly measurable as possible for patients, employees, and/or the organization.

Key points of the Hospital Future Act

On Oct. 9, 2020, the Bundesrat gave the green light for the KHZG, which addresses precisely the hurdle, namely the financing of digitization projects. The homepage of the Federal Ministry of Health talks about a “digital update” for hospitals (BMG 2020). With a total of 4.3 billion euros in investment funds, hospitals are to be comprehensively promoted into the digital age from January 1, 2021. 30 percent of the funding volume is to be covered by the federal states and/or the hospital operators. A total of eleven eligible projects are defined. From interoperability between service providers to digital emergency admission, the projects cover a broad spectrum with a predominant and strong focus on the processes (1-9) in the hospitals. The following overview presents the 11 projects:

  1. Digital infrastructure in emergency departments
  2. Patient portals for digital admission and discharge management and information exchange between the various service providers
  3. End-to-end electronic documentation of care and treatment services and the establishment of systems for automated and voice-based documentation
  4. Partially or fully automated clinical decision support systems to improve quality of care for treatment decisions
  5. End-to-end digital medication management to increase drug therapy safety
  6. In-hospital digital process for requesting services and improving communication processes
  7. Permissible measures for coordinating the range of services between several hospitals to ensure comprehensive care, as well as the provision of secure systems
  8. Introduction and further development of an online-based care record system for beds
  9. Expansion of telemedical network structures between hospitals and with outpatient facilities
  10. Measures to ensure the functionality and security of processed patient information
  11. Adaptation of patient rooms to the special treatment requirements in the event of an epidemic

In addition to the content-related criteria, the first mostly more technically oriented criteria have already been defined that must be met for funding.

  • Interoperability of digital services through internationally recognized technical, syntactic and semantic standards.
  • Compliance with specifications for the integration of open and standardized interfaces
  • Transferability of relevant data and documents into the electronic patient file
  • Ensuring information security and compliance with data protection regulations.
  • Applications for the telematics infrastructure are to be used across all measures if they are available

The funding procedure

The Federal Social Security Office (BAS) is responsible for the overall approval of funds from the Hospital Future Act investment program. From the time the law comes into force until December 31, 2021, states can submit applications for funding to the Federal Social Security Office. The necessary forms are to be made available from mid-November.

The core process for applying for funding is as follows:

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Figure 2: Flow to the process of application

In addition, it is stipulated that the eligibility of certain projects must be checked in advance. The Federal Social Security Office will enable employees of IT service providers with the appropriate qualifications to do this by means of a training program. Confirmation of a positive examination must be enclosed with the application. It is necessary to wait for the concrete funding guidelines from the Federal Social Security Office as well as the criteria defined by the federal states themselves, if applicable, in order to be able to provide further information on the procedure and the requirements. The forms for the needs assessment are expected to be available on the BAS homepage from 16.11.2020. The complete applications including attachments from 30.11.2020, as well as the funding guidelines themselves. The online training program for IT service providers is not scheduled to launch until Jan. 1, 2021.


The evaluation of the investment program is to be accompanied by a research project. The aim is to develop a model specific to Germany based on existing and recognized maturity models. As part of structured self-assessments, hospitals are to determine their digital maturity level. The effectiveness of the Hospital Future Fund and the new digital services introduced as a result is to be evaluated in terms of a before-and-after comparison. An initial measurement is planned for June 30, 2021; a further measurement is then planned for June 30, 2023.

There are already a number of models on the market for measuring digital maturity that are specific to hospitals. In addition to what is certainly one of the best-known models from HIMMS (EMRAM), the College of Health Information Management Executives (CHiME) also offers a measurement tool for digitalization. A model developed specifically for the German market (Check IT) has emerged from a joint project of the Bundesverband Gesundheits-IT (bvitg e.V.) and the Marburger Bund. Which models will serve as the basis for the evaluation measurement tool is still unclear.


As of January 1, 2025, sanctions are possible for all hospitals that do not have the necessary digital services in accordance with the Hospital Structure Fund Ordinance. The contracting parties can agree a discount of up to 2% of the invoice amount for each full and partial inpatient case. The decisive factor is the provision of digital services Nos. 2 to 6 of the Hospital Structure Fund Ordinance. These include: Patient portals for admission and discharge management, end-to-end electronic patient records, clinical decision support systems, digital medication management and digital service requirements (see Figure 2: Overview of eligible projects). The more digital services provided, the smaller the discount.

In light of the current Corona crisis and the accompanying challenges for hospitals, both medical and financial, the 5-year timeframe can be viewed critically. The past few months have shown that hospitals are rightly moving into crisis mode to focus staff resources and concentrate on the essentials – providing medical services to address the crisis. In addition, sanctions, will exacerbate the already tight economic situation of many hospitals and create additional economic pressure.

KHZG – Quo vadis?

Clinics are facing a design-intensive process. The challenge is to synchronize (clinical) processes with the IT landscape so that the organization, information technology and the people involved can work hand in hand to provide the best possible service in the interests of medicine and the patient. Digitization will accompany us for years and decades to come; it is a process of change that thrives on the further development of technical possibilities.

We must learn to evaluate the opportunities and risks of digitization again and again in order to approach the digital world step by step and exploit its potential. At the same time, especially in times of Corona, we must expect the proportion of loss-making hospitals to continue to rise. It remains to be seen whether the KHZG financial injection will actually accelerate the digitization of hospitals to the necessary extent or whether something will have to change fundamentally in the (re)financing of hospitals in order to enable them to invest in the digital world in the long term. After all, systems also generally need more than just an update to ensure their stability and security on an ongoing basis.

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