Insights from EU Health Experts on standards uptake, data quality, and making the Yellow Button vision a reality
To support Task 6.2, Data Collection on EEHRxF Adoption and Hub Performance, of the xShare project, a set of expert interviews was conducted to complement the survey findings and provide in-depth perspectives on the uptake of the European Electronic Health Record Exchange Format (EEHRxF). While the survey aimed to collect broader feedback across EU Member States, the interviews offered qualitative context to help interpret and enhance the survey’s insights. Between February and March 2025, we interviewed 9 experts representing diverse healthcare-related institutions from seven different EU countries. We used a semi-structured format aligned with three core themes: (1) uptake of standards, (2) data quality, and (3) the current state and implementation of EHRs.
Discussions about dependence on national implementations revealed that while infrastructure is important, the effective use of client systems and standard-compliant frontends is more decisive for implementation success. Experts noted that national digitization priorities heavily shape the standard uptake in certain priority categories of data.
Regarding the assurance of high-quality EHR data, experts highlighted that standardized HL7 FHIR elements offer potential for uniformity, but only if used properly. Importantly, the purpose of data collection significantly affects how quality is defined and perceived. Structured, harmonized data collection was seen as critical to achieving reliability, validity, and accuracy. Nevertheless, interoperability alone cannot guarantee data quality: while improving integration can boost data validity, it doesn’t automatically improve overall quality.
Many experts stressed that population-level data tends to be more reliable, while individual patient records remain prone to errors. When discussing technical capabilities, the gap between large hospitals and small practices was frequently mentioned. The former generally have more resources and skilled staff, while smaller providers often depend on external software vendors. To address this gap, the early introduction of information literacy in medical training was recommended.
Furthermore, experts emphasized that the burden of digital transformation should not fall solely on providers; technology must be better integrated into their existing workflows to mitigate risks like burnout. Similarly, from a European patient’s perspective, cross-country differences in data standards are unacceptable.
When discussing how to make the Yellow Button vision a reality, experts agreed that the concept is promising but highlighted several foundational challenges. A key concern was defining what must be in place for the Yellow Button to be accessible and meaningful to the public. Experts noted that Electronic Health Records (EHRs) are typically created by one healthcare provider for use by another, raising the question: if citizens can access this information, what are they meant to do with it? One expert emphasized the need for still greater clarity around the Yellow Button’s functionality, its location, who generates the International Patient Summary (IPS), what happens when a user clicks it, and whether and how they can view their data.
These interviews added valuable context to the survey data, helping identify practical barriers and enablers for standard adoption. Next steps include matching these qualitative findings with survey responses and distilling actionable insights for policy consideration.
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Written by Leen Alsabbagh, empirica.
Contact the author at leen.alsabbagh@empirica.com.
