As the digital transformation of healthcare continues across Europe, the European Health Data Space (EHDS) is widely recognized as a potential gamechanger. At the heart of EHDS lies a fundamental shift: establishing a new set of common European standards for health data sharing across IT systems. One of the most significant enablers of this vision is the European Electronic Health Record exchange Format (EEHRxF).
What is EEHRxF and Why It Matters
EEHRxF builds upon the existing HL7 CDA-based exchange format, but now moves into the more modern HL7 FHIR framework. This transition isn’t merely technological—it’s strategic. EEHRxF introduces requirements for structured and coded health data, allowing not just for data viewing and reading, but also for automated processing and secondary use as well.
By giving EU citizens the right to share their health data across borders, EHDS facilitates better continuity of care. But equally important, EEHRxF opens new opportunities for improving existing national healthcare infrastructures. In Denmark, this translates to a potential shift in how we design and implement our data standards.
Connecting National Standards with European Frameworks
Denmark currently employs several MedCom standards that cover large parts of the electronic health record. Examples include:
- FNUX journal format, used between general practitioner systems, when patients get a new clinic as their gatekeeper
- SUP journal extracts, which transfer data from hospitals and private specialist clinics to the national health record
As EHDS sets requirements for EHR systems to support EEHRxF, it makes strategic sense to plan for the reuse of these European standards when revising national formats like FNUX and SUP. This logic also applies to MedCom standards used for uploads to national databases, such as laboratory report repositories.
While Danish standards often require more detailed information than EEHRxF currently supports, this can be addressed through national extensions. This approach minimizes overall complexity and reduces development burdens on software vendors. Aligning with EEHRxF will also make it easier to procure and implement international health IT systems. Fewer format and terminology conversions mean better data quality and more reliable health information exchange.
xShare: A Practical Example of EEHRxF Alignment
One concrete step toward this alignment is the xShare project, that explores how EEHRxF can be practically implemented within national IT systems.
xShare is not just a technical experiment—it represents a forward-looking approach to ensure Europe remains interoperable, efficient, and aligned with common digital health developments.
The EHDS and EEHRxF represent more than policy—they signal a new era in digital health. By aligning Danish standards with these European initiatives, we can reduce complexity, enhance data quality, and improve system interoperability. The xShare project plays a pivotal role in bridging this transition, demonstrating how European standards can support and strengthen national health infrastructures.
Two key concepts are reuse of the EEHRxF for primary use, extended with a core dataset for secondary use, and an only-once infrastructure, where the same health data can be uploaded once for multiple secondary purposes.
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Written by Michael Johansen, Senior Consultant, MedCom.
Contributors: Janne Rasmussen, Senior Consultant, MedCom; Mie Hjorth Matthiesen, Special Consultant, MedCom.
