Meeting Users’ Needs in National Health Information Infrastructures - Lessons from the Case of Germany

National health information infrastructures (HII) are critical for enabling interoperable and efficient healthcare delivery. However, many national initiatives struggle with misaligned stakeholder interests and unclear roles of regulators. This study investigates a national HII, which includes three important public health applications. Drawing on interviews, participatory observations, and regulatory documents, we examine how stakeholder dynamics and regulatory constraints shape the development process. While existing research has often described such cases, our study adopts a solution-oriented perspective. We derive three actionable recommendations to better align national HII with end-user needs, emphasizing balanced stakeholder involvement, user-centered design, and governance structures that promote healthcare delivery outcomes. Our findings contribute to the literature by extending empirical insights on national HII and offering guidance for governments and policymakers designing similar infrastructures in other countries.