Currently accepted at: JMIR Medical Informatics
Date Submitted: Feb 18, 2026
Date Accepted: Sep 8, 2026
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/93760
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Level of Practice and Alignment With the European Electronic Health Record Exchange Format: Cross-Sectional Survey and Gap Analysis
ABSTRACT
Background:
The European Health Data Space regulation aims to empower citizens and facilitate the seamless exchange of health data across EU Member States. A critical enabler of this vision is the European Electronic Health Record Exchange Format, which establishes a common structure and vocabulary for core health data domains. Despite its strategic importance, the practical implementation of this format faces significant challenges due to the fragmentation of systems, standards, and governance models across Europe.
Objective:
This study aims to assess the feasibility of adopting the European Electronic Health Record Exchange Format by evaluating the current level of practice and alignment across selected healthcare institutions and Member States, focusing on technical, organizational, and semantic readiness.
Methods:
Using a multi-method approach, the study analysed three priority categories: patient summaries, laboratory reports, and hospital discharge reports. Data collection included five feasibility demonstrators involving organizations from Hungary, Portugal, Greece, and Slovakia, complemented by stakeholder workshops and three online surveys. The assessment utilized a dual lens: "Level of Practice" (current availability and structuring of data) and "Level of Alignment" (perceived importance of data fields).
Results:
Analysis of 30 valid survey responses revealed a heterogeneous landscape. Patient summaries showed the highest maturity with 45% structured fields, followed by laboratory reports (35%) and hospital discharge reports (25%). A significant "importance-practice gap" was identified; while approximately 50% of EEHRxF fields were rated as "Very Important," only 30% are currently implemented in a structured manner. Specific semantic analysis of LOINC codes for diabetes management showed limited overlap (only 14 shared codes out of 57 in Hungary and 26 in Portugal), highlighting significant disparities in coding granularity. Technical barriers include reliance on unstructured free-text (up to 39% in lab reports) and the continued use of proprietary or national coding systems.
Conclusions:
While there is strong conceptual alignment with the European Electronic Health Record Exchange Format vision, practical readiness varies substantially across data domains. Transitioning from proprietary formats to EEHRxF-compliant structures requires targeted investments in digital infrastructure, workforce training, and semantic harmonization. The study recommends that policymakers establish clear timelines and incentivize the adoption of standardized templates to bridge the gap between strategic intent and clinical practice.
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