Background: The integration of eHealth solutions into routine health care remains challenging despite their potential to improve care quality and efficiency. Living labs (LLs) have emerged as an approach to addressing these challenges by enabling co-design and iterative testing of eHealth tools. LLs promote collaboration among patients, health care professionals, developers, and policy makers. However, systematic insights into their practical implementation remain limited. Objective: This study explores the use of an LL approach to dynamically create and adapt project workflows, as well as its potential as a methodological framework for developing an implementation plan for a digital prescribing workflow (eRIKA [eRezept als Element Interprofessioneller Versorgungspfade für Kontinuierliche Arzneimitteltherapiesicherheit]). The analysis focuses on intervention-level insights identified throughout the LL process. The study also reflects on the limitations of the approach. Methods: The co-design process was structured into 4 thematic sprints conducted across 3 regions in Germany (Saarland, Berlin, and Westphalia-Lippe) between November 2022 and September 2024. Workshops were held with general practitioners (GPs), pharmacists (PHs), medical assistants, and pharmacy technicians recruited from 6 GP practices, 6 pharmacies, and 1 hospital (n=17). Audio-recorded workshop data were analyzed using reflexive thematic analysis. Results: Three themes were identified: (1) Workflow Efficiency, encompassing demands for filtering and prioritization mechanisms to manage information volume, direct digital communication channels, and concerns about workload; (2) Technical Implementation, addressing the need for seamless system integration, data integrity of the medication history, and interoperability with existing practice management systems; and (3) A New Way of Working, reflecting interprofessional negotiations around roles and responsibilities and regulatory requirements, including data privacy. Notably, strongly divergent views emerged between GPs and PHs regarding what data PHs require to conduct effective medication safety reviews. Conclusions: Consistent with previous research, the results highlight concerns about workload, system interoperability, roles and responsibilities, and regulatory barriers to implementation. Beyond these established challenges, the results also reveal interprofessional tensions between GPs and PHs regarding the extent of data sharing required for effective pharmaceutical counseling. These findings inform the subsequent phase 1 and phase 2 evaluation studies and contribute to the growing evidence base on LL methodology in digital health implementation.

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