EHDS implementation continues – Nordic-Baltic cooperation should too

The European Health Data Space (EHDS) has moved from political agreement to implementation. The goal is to make health data easier to use across Europe, both in day-to-day healthcare and for research, innovation and policymaking. The challenge now is to turn this goal into services, processes and national arrangements that work in practice.

The EHDS provides a common European framework, but it does not prescribe every detail. Member States must still work through choices ranging from governance and legislation to data access and interoperability.

As part of the VALO – Value from Nordic health data project, the Nordic-Baltic Competence Forums were established to help the “New Nordics” prepare jointly for the EHDS implementation. The forums responded to a practical need: even countries with strong digital health traditions have a great deal to navigate as they translate a common European framework into national arrangements that fit their own systems.

Over the past two years, the Competence Forums have brought together representatives of Nordic ministries and authorities, as well as observers from Estonia and Lithuania, in a confidential, trusted environment to discuss the EHDS implementation focusing on the secondary use of health data.

The final Competence Forum takes place in Oslo on 22 September, concluding a series of meetings held in each of the Nordic countries. How cooperation continues after that is still open. But, as implementation moves forward, the need for structured Nordic-Baltic exchange will remain.

No need to reinvent the wheel

The forum participants have focused on the practical choices countries now need to make. These include how to organise health data access bodies (HDABs) to handle data access and approval processes, how to create secure environments for analysing sensitive data, how to build metadata catalogues that help users find available datasets and how to adapt national legislation to the new European framework.

The HDABs are a good example of these choices. Countries are considering different models, ranging from a single national authority to several bodies with shared or divided responsibilities.

The value of these discussions does not lie in reaching identical solutions. The Nordic and Baltic countries are not building the same systems, nor should they. The value lies in seeing how others are approaching similar choices – and in avoiding the need to solve the same problems in isolation.

Towards greater harmonisation

The forums have also helped countries identify where greater harmonisation could support the interoperability needed for health data to move and be used across borders. A common European framework alone will not guarantee that health data can be used seamlessly across countries. Much depends on how countries implement it in practice. By comparing approaches early, Nordic and Baltic countries can identify where alignment may help and contribute practical lessons to European-level work on health data.

Joint work on metadata standards such as the HealthDCAT-AP provides one practical example. It has helped countries reach a deeper common understanding and thus develop more consistent health dataset descriptions and bring Nordic-Baltic feedback into the development of European metadata standards.

Keeping the user journey in view

Importantly, the forums have also helped keep attention on a question that can easily disappear behind organisational charts and legislative texts: what will the experience be like for the people who use these systems?

Therefore, one recurring theme has been the user journey. How do researchers, innovators and other authorised users find health data? How do they apply for access? Where are the delays, bottlenecks and unnecessary complexities? Looking at these questions across countries has made it easier to identify common challenges, consider how access processes could work more effectively in practice and understand where users need support.

Beyond the meetings

The forums have created value beyond the topics on the agenda. Regular dialogue has strengthened the shared Nordic-Baltic perspective in wider European discussions on the EHDS implementation. It has also brought authorities in different countries into closer contact, creating relationships that make it easier to exchange information, seek advice and work together outside formal meetings.

The work ahead

The Competence Forum series is ending at a moment when many of the key structures envisaged under the EHDS are only beginning to take shape. The HDABs are still being established, operational models are still evolving and new issues will continue to emerge as countries move from planning to putting new systems in place.

There is no doubt that the forums have helped the Nordic and Baltic countries enter this next phase with a stronger understanding of the choices ahead. Evaluations consistently point to the same direction: participants value open discussion, peer learning and practical exchange.

With the EHDS services expected to become operational in 2029, countries will continue to face practical choices that are easier to resolve together. The Competence Forums may be drawing to a close, but the cooperation they have enabled should not end with the final meeting. Carrying forward this Nordic-Baltic exchange should now be a priority.

Michel Silvestri is a Senior Adviser at the Swedish eHealth Agency and Chair of the Nordic EHDS2 Competence Forums.