The CMM is a software engineering framework that outlines a 5-level path for systematically and incrementally improving software engineering processes. It was developed by the Software Engineering Institute at Carnegie Mellon University in the 1980s. It is widely used to assess the maturity of an organization’s software processes [53]. The model helps organizations identify and prioritize improvement areas based on their current level of process maturity. Organizations have few defined processes at level 1 (ie, the lowest level of process maturity). By contrast, at level 5 (ie, the highest level of process maturity), organizations have well-defined, highly optimized processes that are continually improved. The CMM focuses on process improvement and process maturity domains and subdomains, making it a valuable tool for organizations seeking to improve their software engineering processes [54,55] (Textbox 3 [53]).

The CMMI is a framework devised by the Software Engineering Institute at Carnegie Mellon University in the early 2000s. It offers a structured approach to enhancing software engineering processes [56]. It outlines a 5-level path for enhancing the processes incrementally (Textbox 4 [56]). The first 3 levels correspond to the capability levels of the CMM, and the fourth and fifth levels represent advanced improvement [57]. The CMMI has 4 main domains: process, project, engineering, and support. Each domain is further divided into subdomains [58]. The process domain includes planning, resourcing, deploying, implementing, monitoring, controlling, apprising, measuring, and improving processes.

The project domain encompasses project design, development, and validation, while the engineering domain covers system and software engineering activities, including development and maintenance. Finally, the support domain focuses on support product development and maintenance [57]. The CMMI framework helps organizations improve their processes and expand their capabilities.

The EMRAM, created by the Healthcare Information and Management Systems Society (HIMSS), offers a comprehensive framework for evaluating the maturity of electronic medical record (EMR) systems within health care institutions [19]. Comprising 8 stages ranging from preadoption to EMR optimization, the model delineates the evolution of EMR adoption and use (Textbox 5 [59]). Developed in collaboration with clinicians and health care IT experts worldwide, the EMRAM integrates seamlessly into clinical workflows. It facilitates comparative assessments of EMR progress across organizations. Consequently, it serves as a vital tool for health care entities to gauge and enhance their EMR implementation, ultimately elevating the standard of patient care.

The CCMM is a powerful framework that helps health care organizations deliver seamless patient care across multiple care sites and health care providers [21]. Developed by the HIMSS, the CCMM builds on the EMRAM, enhancing patient care by ensuring effective communication and teamwork among health care professionals. The CCMM delegates responsibility for coordinated care to administrators and governance leadership, clinical leadership, and IT and technology leadership, enhancing interoperability, governance, workforce efficiency, and predictive analytics within digital health [10].

The CCMM comprises the 5 domains of governance, engagement, processes, information, and technology, each with several subdomains that indicate the corresponding maturity level (Textbox 6 [59]). The governance domain includes organizational structure, policies and procedures, and risk management. The engagement domain covers values, beliefs, communication, training, and education. The processes domain focuses on care coordination, care transitions, and disease management. The information domain includes data collection, management, decision support, and reporting and analytics. Finally, the technology domain covers system architecture, security and privacy, and interoperability [60].

Unlike the EMRAM, which focuses on specific aspects of EMRs, the CCMM takes a holistic approach to measuring maturity, emphasizing continuity of care and seamless patient information sharing among diverse health care providers. Developed collaboratively by the HIMSS and health care professionals worldwide, the CCMM is a valuable tool for health care organizations to assess, implement, and scale coordinated care.

The CDMI is a valuable tool introduced by the National Health Service in 2013. It was updated in 2016 to measure and track the progress of digital maturity within health care organizations in the United Kingdom [20]. It encompasses 3 key dimensions: capability, technological readiness, and infrastructure. The capability dimension assesses whether an organization possesses a well-defined digitalization strategy, effective governance structures, and adequately trained staff. The technological readiness dimension assesses the availability, effectiveness, and adaptability of technology to support digitalization efforts. Finally, the infrastructure dimension evaluates physical data and information management as well as the security infrastructure within the organization [20]. Each CDMI dimension is further divided into 14 sections, enabling a comprehensive assessment of an organization’s digital maturity level. With the CDMI, organizations can identify their strengths and weaknesses in terms of digital readiness and devise strategic improvement plans [60]. While the HIMSS maturity model may not be directly applicable in the UK context, the CDMI serves as a tailored and invaluable tool specifically designed for the UK market, offering a robust framework for assessing and advancing digital maturity within health care organizations. Furthermore, the framework facilitates monitoring progress and changes over time, fostering transparency and accountability (Textbox 7 [20]).

The IMM was developed by the National E-Health Transition Authority of Australia to aid health care organizations in evaluating their level of interoperability maturity. Primarily, the IMM is structured around 5 stages of the CMMI, accompanied by a set of interoperability goals and an evaluation model geared toward the national level [21]. These stages are intricately linked to organizational, informational, and technical dimensions at various levels, including local, corporate, and national scales. The model delineates interoperability targets to enhance scalability, scope, and configurability across these dimensions [22].

The organizational dimension addresses business and governance considerations, ensuring alignment with strategic objectives. The informational dimension focuses on data format and semantics, ownership and rights, and standard building blocks, facilitating effective data exchange. Finally, the technical dimension encompasses specifications related to interface, functional decomposition, and communication protocols, which are vital for seamless interoperability. Although the IMM does not explicitly address architectural and technical policy separation, it furnishes health care organizations with a comprehensive framework to navigate their interoperability goals effectively [22]. By emphasizing these aspects, the IMM enables the development of robust interoperability strategies aligned with business objectives. Overall, it is a valuable tool for health care organizations to assess their interoperability maturity and devise plans for continuous improvement [52] (Textbox 8 [61]).

The TMSMM is a comprehensive assessment tool designed to evaluate a telemedicine program’s readiness to implement and sustain a successful telemedicine initiative [23]. Developed by telemedicine practitioners from 5 South African provincial health departments, it focuses on various aspects of telemedicine application, particularly during the patient treatment stage [24]. This model encompasses 5 key characteristics—man, machine, material, method, and money—providing a holistic view of implementing a telemedicine service. The assessment is conducted through micro- and macro-level processes, with the maturity scale based on the generic-level indicators of the CMM.

However, the TMSMM consists of 5 levels, each representing a different stage of maturity in telemedicine service delivery. These stages are based on the program’s ability to provide telemedicine services effectively and efficiently and its readiness to expand and sustain these services over time. The 5 levels are the initial stage, the experimental stage, the expansion stage, the consolidation stage, and the transformation stage. At the initial stage, telemedicine services are in their infancy phase, with limited reach. Progressing to the experimental stage, services are tested and evaluated for effectiveness [62]. In the expansion stage, services are scaled up, extending their reach to more patients and health care providers. Upon entering the consolidation stage, telemedicine services are fully integrated into the health care system. They are becoming an integral part of the health care delivery model. Finally, the transformation stage represents the highest level of maturity, where telemedicine services have transformed the health care system and have led to significant improvements in patient outcomes, provider efficiency, and cost savings (Textbox 9 [24,25]).

The DRMM is a framework designed to assess digital transformation in hospitals, primarily focusing on health care institutions in Germany. It evaluates digital maturity by analyzing organizational processes, clinical applications, and technology infrastructure [63]. The model uses a structured web-based self-assessment through which hospitals evaluate their capabilities in clinical, administrative, and IT processes. These assessments generate individual scores, offer benchmarking insights, and guide strategies for digital transformation to improve patient care and hospital operations [63].

A key feature of the DRMM is its alignment with the funding requirements of Germany’s Hospital Future Act, linking digital maturity directly to external funding opportunities. This alignment incentivizes hospitals to engage in the self-assessment process. The model’s comprehensive methodology thoroughly evaluates IT performance, clinical workflows, system resilience, and telehealth capabilities [63].

The DRMM incorporates feedback from diverse stakeholders, including clinical staff, information management teams, and administrators, ensuring a broader representation of perspectives within the hospital’s digital ecosystem [48,63]. In addition, it provides a public dashboard for transparency, enabling hospitals to compare their scores against national benchmarks. This feature promotes competition and collaboration to improve health care delivery [48,63].

Despite its strengths, the DRMM has limitations. It is designed to closely align with Germany’s health care policies, which may restrict applicability in countries with different regulatory frameworks or digital infrastructures [63-65]. The reliance on self-reported data can introduce bias because hospitals might exaggerate their capabilities to meet funding criteria or performance targets [63]. Furthermore, while the model emphasizes technical and procedural dimensions, it gives limited attention to social and cultural factors, such as staff adoption of digital tools, which are crucial for effective digital transformation [63].

The DRMM outlines 7 maturity levels, describing the progression from basic infrastructure to fully integrated digital health systems. These levels are summarized in Textbox 10 [63], detailing critical aspects of digital health implementation [48,49,63].

Digital communication components within the DHMM framework are crucial in completing assessments. Unlike traditional DHMMs focused on technical features, communication dimensions practically include user connectivity, acceptance, personalization, and customization, which are critical factors in digital health platforms [51]. These elements can give DHMMs a coherent approach to evaluating a digital health management organization. They capture technical capabilities and examine the quality of patients’ and stakeholders’ interaction and communication experiences. This integration can uncover the benefits of digital health methods and progress regarding needs [20]. The process lays the groundwork for digital health projects to align with users’ needs and preferences, leading to more efficient and popular digital health solutions.

The digital health communication maturity model (DHCMM) represents a paradigm shift in digital health maturity assessment. Unlike the other DHMMs, which tend to overlook the communication dimensions [25], the DHCMM is unique in that it incorporates specific user-centered metrics such as satisfaction, engagement, personalization, and customization into its framework (Figure 4).

Therefore, the DHCMM is ultimately key to assessing an organization’s readiness and capabilities for successfully implementing its digital health communication strategies [37]. By blending in communication models, the framework provides a more comprehensive take on the relationships among patients, digital health tools, and communication mediums, covering the aspects of channels, messaging, and user experience [38].

The core idea of the DHCMM is the dual requirement to have effective communication as a driver of technology and as the primary source of success in digital health initiatives [39]. Hence, communication strategies should be custom tailored to suit different user profiles, adapting to the evolving needs and preferences of a diverse population [40].

For a range of health care settings, from private clinics to public health campaigns and consumer-facing digital health care platforms, the DHCMM provides a structured approach to assessing communication effectiveness and identifying areas for improvement [20].

In other words, the DHCMM is a product of the latest digital technology development. Its introduction in digital health evaluation represents major progress because it offers a robust framework for assessing and improving communication practices in the digital age [39]. By instilling collaboration, governance, and meaningful engagements with eHealth applications, the model offers paths to more efficient and user-centered digital health development.

Effective communication is crucial for the success of digital health initiatives, irrespective of the technological infrastructure [13]. At the same time, social factors such as user experience and communication significantly influence the acceptance and use of digital health solutions. Thus, overlooking these social capability aspects during digital health maturity assessments can undermine even the most advanced technological implementations [14]. In response to this dynamic nature of digital health, this review introduces the DHCMM, which addresses the limitations of existing DHMMs. The proposed model integrates DHMMs, communication, engagement factors, and technological dimensions, offering a precise road map and addressing crucial gaps to provide a nuanced view of an organization’s digital health maturity in the complex digital health landscape.

Current DHMM versions primarily focus on stabilizing the digital health system. However, it is imperative to incorporate bidirectional aspects such as the CCMM and DRMM to enhance user engagement at the community level. Such additions are expected to improve the operationalization of the digital health ecosystem, extending from hospital care to community care. In this context, an expanded maturity model, as depicted in Figure 4, introduces an engaged stage alongside the capability and advanced stages.

Level 6, the integrated level, emphasizes coordinated data and governance procedures, actively involving health care professionals, patients, and community members. Level 7, the engaged level, underscores the importance of the active involvement of organizations, community members, and physicians throughout the health care system.

A 7-level framework can be used to conceptualize digital health systems. The first 3 levels—initial, managed, and defined (standard)—constitute the capability stage. The qualitatively managed and optimized levels form the advanced stage. The integrated and engaged levels emphasize active user engagement and provide a platform for the active exchange of information while developing digital health capabilities in recently adopted areas and focusing on the effective use of advanced capabilities.

Overall, the proposed integrated DHCMM offers a more comprehensive approach to measuring the maturity of digital health systems, incorporating communication and engagement aspects not addressed by DHMMs. This model provides a framework for actively engaging users and stakeholders in the digital health ecosystem, emphasizing the importance of collaboration, governance, and the effective use of digital health capabilities.

The DHCMM offers a comprehensive approach to evaluating digital health systems, incorporating crucial communication and engagement aspects overlooked by DHMMs. This model emphasizes collaboration, governance, and the effective use of digital health capabilities to actively engage users and stakeholders in the digital health ecosystem.

The 7 crucial domains of maturity—process, information (or data), technology, governance, management, engagement, and communication—collectively contribute to ensuring optimal outcomes in digital health systems. The process and technology domains focus on establishing the necessary infrastructure to support digital health initiatives. Governance and management are essential in efficiently applying digital health technology, encompassing organization-wide strategy, decision-making, and process management standards. Finally, the engagement and communication domains highlight the significance of social capabilities in successful digital health implementation. Engagement involves adapting to process changes, values, beliefs, attitudes, and behaviors, while communication emphasizes effective communication and cooperation within the process management framework.

The integrated DHCMM offers a comprehensive assessment of digital health system maturity, encompassing all relevant domains. Through its thorough coverage of these domains, the model ensures that systems are optimized for success, with a strong emphasis on user engagement and personalized care.

The effective execution of digital health programs hinges on collaborating with various stakeholders, including patients, legislators, health care professionals, and technology developers. While DHMMs have achieved significant progress in evaluating technology capabilities, the integrated DHCMM critically emphasizes stakeholder alignment. Efficient communication and cooperation among different groups are vital for aligning stakeholders and ensuring that the digital health ecosystem meets the requirements and expectations of all stakeholders. The DHCMM acknowledges the importance of this alignment within its governance and engagement domains. Governance establishes the legal frameworks and collaborative agreements, creating an environment conducive to digital health initiatives. It ensures that policies and regulations evolve alongside emerging technologies [13].

Moreover, the engagement domain underscores the importance of community involvement, user interaction, and effective communication techniques. Unlike traditional DHMMs focusing solely on technology infrastructure, the DHCMM acknowledges the broader scope of digital health maturity, considering the social aspects involved. It emphasizes active engagement from patients, health care professionals, and communities, recognizing their significant role in the success of digital health initiatives. The stakeholder-centered strategy of the DHCMM bridges the communication gap among important actors to achieve optimal outcomes. Likewise, technological proficiency calls for recognizing and addressing stakeholders’ various requirements, values, and beliefs [14]. This concept compels enterprises to consider the human factor in digital health, understanding that successful adoption requires more than cutting-edge technology.

Furthermore, the integrated DHCMM expands on the topic beyond technology by emphasizing the role of stakeholder alignment in achieving digital health maturity. Through its assessment of the efficacy of communication, engagement, and governance frameworks, the model offers an all-inclusive road map for businesses to navigate the intricacies of the digital health terrain. While digital health technologies have revolutionized health care by improving communication and patient care, the lack of a standardized measure for digital health maturity presents a significant challenge. While existing maturity models are outlined in this review, a more detailed analysis is warranted.

The DHCMM also stresses the significance of persistent monitoring and evaluation in achieving progress in digital health communication strategies and battling misinformation. By latching onto key performance indicators and altering the approaches, organizations can tweak the use of their digital health capabilities and eventually improve the overall effect on health care outcomes.