Purpose/Significance To explore the conditional configurations and mechanisms of performance variations of hospital-led internet hospitals in Central China, so as to provide references for the digital transformation of regional hospitals and the enhancement of medical service efficiency. Method/Process An analytical framework is constructed based on the technology-organization-environment (TOE) framework, and a fuzzy-set qualitative comparative analysis (fsQCA) is applied to conduct configuration analysis on 67 case studies of internet hospitals led by tertiary hospitals across Hunan, Hubei, and Henan provinces. Result/Conclusion Three distinct pathways driving high performance are identified. Factors such as organizational, technical, and environmental conditions play differentiated roles in various pathways. Hospitals should select development paths that align with their resource conditions and external environments.