DigiH4A (Digital Health for All) is closing the gap between digital health SMEs and the hospitals and providers that need their solutions. Drawing on seminars and workshops with decision-makers, healthcare providers and SMEs across Germany, Sweden, the Netherlands and France, this article shares the cross-country lessons on what blocks the uptake of digital health solutions across different European settings — and what practical tools are needed to make implementation easier.
DigiH4A aims to help Europe’s healthcare systems deliver better, more cost-effective care. Many digital solutions already exist to support this shift — but too often, they struggle to move from the SMEs that develop them to the hospitals and other providers that need them.
To close this gap, DigiH4A is working directly with decision-makers, healthcare providers and SMEs across Germany, Sweden, the Netherlands and France to identify the key hurdles that need to be cleared — and co-develop the practical solutions that can help clear them. As part of this effort, we invited key stakeholders from each of these sectors to a series of seminars and workshops to explore what blocks the uptake of digital health solutions in each of their countries and what would ease implementation. This article shares the cross-country lessons and insights gathered from those sessions.
Navigating the maze of reimbursement and regulation
A primary focus of the workshops was understanding the payment processes for new digital health solutions, in other words: reimbursement pathways. This varies between countries. In more structured systems such as Belgium and France, SMEs often face complex “multi-entry” reimbursement pathways, where funding decisions depend on the type of solution and the maturity of the clinical evidence behind it. In Denmark and Sweden, stakeholders described a far more fragmented landscape, with no single national route — meaning digital health solution providers may have to approach multiple regions or municipalities one by one.
Across both contexts, one message was consistent: reimbursement should not be regarded as a final administrative step, but instead should be viewed as a central part of how digital health solutions are designed, evidenced, and brought to market.
The bottleneck of evidence and clinical alignment
Across all countries, a major hurdle remains the level of proof required by evaluation bodies before a digital health solution can be procured. Stakeholders emphasised that regulators do not assess solutions in isolation, but instead judge the specific value the service adds compared to the current standard of care. For SMEs, this means prioritising high-quality clinical evidence and demonstrating organisational impact (for example reduced hospitalisations or improved workflow efficiency) from an early stage.
At the same time, participants stressed that “evidence” is only part of procurement readiness. Solutions must also meet baseline requirements around cybersecurity, interoperability and data protection — areas that often bring a significant compliance workload. As with reimbursement, a recurring message was that these requirements need to be built in early.
Financial misalignment and the need for systemic reform
Another recurring theme to emerge from the workshops and seminars was a structural misalignment between how healthcare is currently funded and what many digital tools are designed to achieve. In fee-for-service settings, hospitals and providers can be financially disadvantaged when solutions reduce in-person visits — as several stakeholders put it, “taking contact away means taking money away”. At the same time, local organisations often carry the upfront costs of implementation (IT integration, staff training, change management), while the financial benefits are often felt elsewhere in the system through longer-term efficiency gains.
Discussions highlighted a shared need for stronger policy and payment mechanisms that reward outcomes and make uptake economically viable for providers. Stakeholders referred to options such as quality- or outcomes-based incentives, clearer national or regional reimbursement routes, and more top-down support to reduce fragmentation and de-risk procurement — especially for solutions that deliver system-wide savings but require local investment.
Other themes that surfaced: patient literacy and equitable access
Beyond reimbursement and procurement, participants also flagged a more human challenge: awareness and digital literacy can still determine who benefits from digital health. In several countries, patients often discover tools through informal networks or family rather than through consistent guidance in the care pathway. Stakeholders mentioned ideas such as “low-threshold” support roles (for example digital health navigators) and simple, guided access points that help people choose and use tools safely.
While this sits partly outside DigiH4A’s direct scope, it remains a useful lens for the project’s work: solutions that are technically sound and reimbursable still risk low uptake if end users are not supported. These potential risks around accessibility and user guidance are important to keep in mind to ensure that adoption efforts do not unintentionally widen health inequalities.
Next steps: turning insights into informed action
Building on these cross-country insights, the DigiH4A partnership is now developing products designed to tackle the hurdles identified in the workshops. The upcoming pilots will put these ideas into practice — testing reimbursement approaches, evidence generation, and cost–benefit models in real-world settings. The goal is clear: to deliver tools that are not only innovative, but genuinely useful, scalable, and ready for uptake across Europe’s healthcare systems.