[For discussion: The state of digitization of the German healthcare system].

The state of digitization of the German healthcare system has often been characterized as unsatisfactory. This euphemistic classification suggests a problem of implementation. In reality, however, the problems lie much deeper in the structure of the German healthcare system, which makes both the establishment of a comprehensive eHealth governance and the sustainable implementation of digital transformation virtually impossible. Actors that could promote digitization are either not well organized (patients) or have got stuck in the last century technologically (hospitals). Focusing on ambitious large-scale projects while at the same time facing essential problems of interoperability and governance, pragmatic solutions on a small scale are blocked and multiple legitimations for non-action are created. In mobile health apps, problems and solutions accumulate. The only question is whether in the end the persistence forces of the German healthcare system will plunge the American internet giants into lethargy or whether these will take over data sovereignty in the German healthcare system through useful and usable applications.