Electronic health records (EHRs) are a key component of health systems’ digital transformation, but their successful implementation requires comprehensive technical, legal, and operational preparedness. This includes ensuring patient-provider accessibility, establishing standardized data sharing protocols and implementing secure information management systems.
In 2023, EU countries have made significant investments to ensure reliable nationwide access to EHRs, with the average availability of online digital health services (expressed by the Digital Economy and Society Index) rising by 8 percentage points from 2022 to reach an average of 79% (Figure 8.11) (European Commission, 2024[1]). The Slovak Republic, France and Portugal demonstrated significant progress in expanding their digital health services, as evidenced by substantial improvements in their digital health scores. Ireland also made noteworthy advancements, with its score increasing from 0% to 11% in 2023 following the implementation of Electronic Health Record (EHR) access in a major private hospital group (European Commission, 2024[2]). As of 2023, all Belgian residents have access to their electronic health records (EHRs), and core functionalities such as unique patient identification, allergy lists and e‑prescriptions have been implemented in all general hospitals. At the same time, some EU countries saw lower scores following strategies revisions or deficiencies in technology infrastructure. For example, Finland’s score dropped by 9 percentage points due to more accurate reporting mechanisms, while Cyprus’ score declined by 3 percentage points because of shortcomings in authentication technologies and accessibility standards (European Commission, 2024[2]).
Health systems resilience is also determined by accessible, linkable health datasets. Such data integration enhances patient safety, strengthens public health preparedness and healthcare management (OECD, 2023[3]). At least 15 European countries report having available health datasets, with Denmark and Norway guaranteeing full availability across all ten key health dataset types while Austria, Estonia, France, the Netherlands, and Sweden follow closely with 92% availability and linkability for secondary use. Several technical factors influence record linkage capacity, including the availability and consistent use of a unique ID as well as the regularity of dataset linkages. Czechia, Finland, Denmark and Sweden use a unique patient/person identifier for linking over 90% of their national health datasets, while Estonia, France, Latvia, Luxembourg, the Netherlands, Norway and Slovenia use this ID for over 60%. Czechia, Denmark, Finland, France, Latvia, the Netherlands, Norway, Slovenia and Sweden regularly link most of their national datasets, but in Austria, Belgium, Estonia and Luxembourg, linkages are limited to a few datasets, and none are regularly conducted in Germany or Ireland (Figure 8.12) (Oderkirk, 2021[4]).
Building on these national efforts, in 2024 the European Parliament and the European Council approved the establishment of a European Health Data Space (EHDS), aimed at empowering EU citizens with greater control over their health data and enabling secure, efficient data exchange for healthcare providers, researchers and policy makers. The EHDS sets rules for both primary use (patient care) and secondary use (research, innovation, policy making). Implementation is phased, with primary use exchanges set to begin by 2026 and secondary use rules effective from 2028 (European Commmission, 2024[5]).
