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The successful introduction of digital health solutions in German hospitals requires the interaction of organizational, technical, and regulatory prerequisites. Although KHZG (Krankenhauszukunftsgesetz) funding and initiatives such as DigitalRadar have achieved measurable progress, structural deficits remain, particularly in cross-institutional cooperation, interoperability, and sustainable scaling. From an organizational perspective, systematic change management is key: digital innovations must be embedded in clearly defined processes and accompanied by early stakeholder involvement. Standardization at the process and role level greatly facilitates implementation. Technically, interoperability, for example via HL7 FHIR and semantic standards such as SNOMED CT, is a basic requirement but is impaired by proprietary systems and incomplete implementation. A resilient IT infrastructure, flanked by B3S-compliant security standards, forms the technical basis. Cross-provider models such as hospital cooperatives address resource bottlenecks in small facilities. Regulatory requirements (EU GDPR, IT-Sicherheitsgesetz—“German IT Security Act 2.0”) and new standards such as the AI Act must be observed, especially for AI applications. Governance for such systems is not yet sufficiently established. Acceptance by patients and health professionals is a critical success factor. User-friendliness, transparent communication, and targeted training measures are crucial here. Cultural factors such as digital literacy and error culture also have a significant influence on implementation. Frameworks such as NASSS (“Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability”) explains why health and care technologies succeed or fail across seven interacting domains—the condition, the technology, the value proposition, the adopter system, the organization, the wider system, and embedding/adaptation over time—offer structured orientation models for sustainable scaling. The European Health Data Space (EHDS) will create uniform framework conditions for cross-sector data exchange in the future. Long-term success requires continuous evaluation, flexible adaptability, structurally anchored financing, and the establishment of learning organizations.