The European Commission (EC) has published a report on the state-of-play on Europe's delivery of the Digital Decade's e-Health target of 100% of EU citizens having access to electronic health records by 2030. Based on a dedicated study, the report outlines Europe's and European countries' progress made in 2023.
Source: Digital Decade 2024: eHealth Indicator Study
The Digital Decade Policy Programme 2030 is driving progress towards universal access to electronic health records for EU citizens and the empowerment of patients through digital health.
The use of health data and of digital health technologies (eHealth or digital health) shows great potential in the field of health and care. It can improve access to health services by citizens, increase the quality and efficiency of healthcare, develop personalised approaches, and support research and innovation.
What is the study about?
The study has examined the progress made by the 27 EU Member States (EU-27) regarding the citizens’ access to their electronic health records. It also includes findings from Iceland and Norway. The results describe European countries' state-of-play as of 31 December 2023. The study data was gathered between April and May 2024. Respondents were national competent authorities.
A 68-page report has been published, based on the study. The study itself was conducted by Gapgemini Invent (formerly Capgemini Consulting), an arm of one of the leading global management consultancies, on behalf of the European Commission's DG CNECT.
Embedded in the full report is an executive summary available in the English, French, and German languages (two of these are available separately). Of particular interest is an annex containing a sequence of 4-page summaries on the status of each of the 29 countries involved. See For more background information.
A composite indicator was used to monitor progress made by the 29 countries. Originally developed in 2022, the indicator incorporates four 'layers'. These four analyse various aspects of access to eHealth records:
- the implementation of electronic access services for citizens.
- categories of accessible health data.
- access technology and coverage (e.g., eID, and access via portals or apps).
- access opportunities for certain categories of people.
General status: Enabling citizens' access to eHealth data
Europe is improving the maturity of the eHealth indicator. The overall EU27-average composite score increased by seven points in 2023 (it moved to 79% from 72% at the end of the previous year).
Countries are progressing well in facilitating citizens’ access to electronic health records. Four-fifths of European Member States (81%) improved their own indicator score during 2023.
By the end of 2023, all Member States (100%) provided some form of national or regional online access service(s) for citizens to access their health data. Four Member States (Ireland, Italy, Spain, and Sweden) describe having regional services for electronic access for citizens.
Improvements have occurred in: the availability of different data types e.g., electronic results and reports; the connectedness of categories of healthcare providers that supply data; and an increase in online access services that follow web content accessibility guidelines.
There are, however, several areas in which further progress can be made. To meet the 100% target in 2030, access will have to become universal. More healthcare providers - especially private providers - will need to become connected to the access services. Certain data types will need to become more available especially data about e.g., medical images and medical devices/implants. Full implementation will need to be ensured of relevant legal instruments: examples include the eIDAS Regulation and the Web Accessibility Directive.
Two specific insights follow on findings related to the top five countries, and two specific aspects of categories of health data and access to technology/coverage.
The top five countries
The top five most mature countries in the EU-27 are Belgium (100%), Denmark (98%), Estonia (98%), Lithuania (95%) and Poland (90%). The biggest improvements in 2023 were observed for France (+25 points), Portugal (+23 points), Slovakia (+20 points), and Germany (+17 points).
The top five countries are described as trendsetters. Other clusters of countries include fast-trackers, followers, and beginners.
Source: Digital Decade 2024: eHealth Indicator Study
Health data and access technology and coverage
In over 30 pages, the study report describes in a detailed way the four layers of activity on access to patients' electronic health data in Europe. Two areas of activity are reported on here.
Categories of accessible health data:
As a whole, the EU-27 achieved an average score of 74% on the thematic layer for the categories of accessible health data, a growth of 10 percentage points since last year.
The most mature health data categories include data about identification (94%), personal information (90%), ePrescription (85%), eDispensation (81%), current and relevant past medicines (79%), and laboratory test results (78%).
Seventeen Member States (63%) made improvements either by providing more categories of health data or supplying the available data in a timely manner.
The least mature categories of data include data about procedures/operations (70%), hospital discharge reports (69%), medical devices and implants (52%), and medical images (26%). Nevertheless, six countries managed to make medical imaging reports available by the end of 2023 in contrast to the previous year.
Source: Digital Decade 2024: eHealth Indicator Study
Access technology and coverage:
In 2024, the EU-27 average for the thematic layer about access technology and coverage reached 80%, an improvement of seven percentage points since the previous year.
All Member States - except one - offer access to electronic health data through an online portal. Fourteen Member States (48%) report offering citizens both online portal(s) and native mobile application(s) as modes to access their electronic health records. In terms of population coverage, 20 Member States (74%) report that 80-100% of the national population can - technically - make use of the online access for electronic health records to view their health data. In total, 16 Member States improved their score(s) in the field of access technology and coverage.
Public healthcare providers (72%) are better connected than private healthcare providers (55%). Only seven Member States (26%) report that at least 60% of healthcare providers - across all applicable categories of facilities (e.g. primary care facilities, secondary care facilities, and nursing homes for older adults) - supply at least some relevant data to the access service. Nonetheless, 11 Member States (41%) expanded their number of categories of connected healthcare providers since last year.
Seventeen Member States (63%) enable citizens to use a secure eID (pre-) notified under the eIDAS Regulation in order to authenticate themselves when using the online access service. Last year, in contrast, only half of European Union countries had their eID (pre-) notified in compliance with eIDAS Regulation.
An overview
This comprehensive monitoring framework was developed in close cooperation with Member States, and is now being applied. It provides concrete tools for monitoring and annual reporting on the advancement towards achieving digital targets and objectives to be reached by 2030.
Indeed, the framework and study is "designed to provide a comparable, year-on-year snapshot of progress towards the Digital Decade target for eHealth." (p65)
In comparison to previous studies, this survey tends towards describing real data-sharing, and patient access/control.
Clearly, progress has started to be made year-on-year. Countries will find it useful to substantiate their own progress. They may also find it interesting to compare their progress to others. Learnings can no doubt be shared between and among trend-setters, fast-trackers, followers, and beginners.
The strategic importance of working towards 100% achievement
Working towards 100% achievement of these Digital Decade eHealth targets is important for the whole of Europe and for each Member State/country involved.
There are enormous benefits involved in the results, e.g., for citizens'/patients' empowerment.
To get to a 100% level of achievement, what is needed includes moving ahead strategically on:
- Breaking down the barriers to data-sharing.
- Integrating data from several/many different sources.
- Incentivising enhanced data-entry of structured data for health-care providers that are either public or private.
A number of challenges remain on eHealth/digital health both for Europe as a whole and especially for beginner and follower countries. Given upcoming changes in technologies and organisations, countries may also need to work hard to continue to maintain 100% accomplishments annually over the coming six years till 2030. Staying both "on track" and "at scale" may be challenging at times. (For example, some countries discovered that certain of their scorings actually diminished in 2023 - due to the fact that they were able to report data more accurately and completely.)
It is clear that this eHealth indicator target supplements activities dedicated to making progress on the European Health Data Space (EHDS). As the conclusions of this study suggest: "The eHealth target and the EHDS are complementary. Member States should find the relevant synergies in their efforts to meet both these sets of requirements." (p65)
For more background information
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In addition, EHTEL has itself set up an EHDS Implementers' Task Force. Among one of its initial topics for exploration will be the implications of the eIDAS regulation, and the establishment of a European Digital Identity Wallet for the European Health Data Space.
Earlier findings from 2022-2023, that reflect the design of the original eHealth monitoring framework, were reported in February 2024.