Challenge
The European Electronic Health Record Exchange Format (EEHRxF or X Format) is a cornerstone of the European Health Data Space (EHDS), designed to enable the secure, interoperable exchange of health data across EU borders. However, despite the technical standard’s availability, its real-world application remains limited. Without large-scale, in-service demonstrators embedded into real healthcare settings, the format risks remaining a theoretical framework rather than a practical tool for improving healthcare delivery. The challenge is dual: first, ensuring the EEHRxF can be effectively integrated into diverse healthcare systems without creating additional burdens for healthcare professionals; second, demonstrating to policymakers, clinicians, and IT developers that the format can generate real value, both clinically and administratively, through better interoperability and data accessibility.
Solutions
The i2X project (Intelligent Implementation of the European Electronic Health Record Exchange Format) was launched to directly address these implementation gaps. Coordinated by UpHill, the project involves over 40 partners across 12 EU countries, representing a wide range of healthcare providers, public institutions, IT vendors, and research organizations.
i2X aims to implement 40 real-world, in-service pilot demonstrators that utilize the EEHRxF in five priority data categories:
- Patient summaries
- E-prescriptions and e-dispensations
- Laboratory results
- Medical imaging
- Hospital discharge reports
These demonstrators will operate in 13+ healthcare settings ranging from national hospitals to regional eHealth agencies. Each pilot is tasked with showcasing that X-Format implementation can be sustainable, improve care delivery, and support the secondary use of health data. The project also includes extensive support in digital health ecosystem building, workforce engagement, and measuring the economic and health value of the pilots.
Results
The expected impacts of the i2X project are significant both in scope and relevance to EU health policy. The initiative will generate robust, practical evidence that structured and standardized electronic health records can positively influence healthcare outcomes, data fluidity, and system efficiency.
Key projected outcomes include:
- A 75–80% increase in structured health data availability in participating settings
- Improved access to health data for more than 3 million EU citizens
- Engagement of 1,200+ healthcare professionals, enabling widespread learning and feedback
- Enhanced cross-border healthcare and clinical continuity for mobile EU patients
- A roadmap of “”lessons learned”” to guide future implementers and inform policymakers
By bridging technical infrastructure with clinical realities, i2X helps transform the EEHRxF from an abstract standard into a functional backbone of the EHDS.