Only 27% of European Hospitals Achieve Full Patient Data Exchange Across Borders Despite EU Interoperability Mandates

Black Book survey reveals just 1 in 4 hospitals can fully exchange patient data across national boundaries in Q4 2025

VIENNA, AT / ACCESS Newswire / October 21, 2025 / As Europe advances toward the European Health Data Space (EHDS), a new Black Book Research regional pulse survey exposes persistent interoperability barriers stalling seamless cross-border data exchange.

While interoperability readiness has improved by nine percentage points since 2023, a fraction of European hospitals report achieving full cross-border data liquidity , meaning structured, standards-based patient information can flow freely across systems and national jurisdictions without manual intervention or file conversion.

Key Technical Findings

27% full interoperability, up from 18% in 2023 – progress, but still short of EHDS compliance thresholds.

42% partial interoperability – functional within domestic ecosystems but lacking cross-jurisdictional API alignment.

31% isolated systems, still dependent on HL7 v2 messaging or static document exchange.

54% cite lack of standardized FHIR-based APIs as the top constraint.

49% point to regulatory fragmentation and divergent national security frameworks.

68% plan major investments in data-mobility infrastructure and semantic harmonization in 2026.

Regional Readiness Snapshot

Nordic and Benelux regions lead, averaging 47% cross-border connectivity through interoperable cloud adoption and eID integration.

France and Germany show the steepest improvement, driven by ENS and Gematik interoperability roadmaps aligning with EHDS schemas.

Southern Europe trails at 14%, hindered by legacy vendor architectures and inconsistent open-API compliance.

“European healthcare IT stands at a critical inflection point,” said Doug Brown, Founder of Black Book Research. “The frameworks exist (FHIR, IHE XDS, ISO 13606) but operational alignment and semantic coherence still lag behind the ambition. We’re witnessing a shift from document exchange to true data orchestration. The EHDS has catalyzed intent; now the next 18 months must deliver executable architectures, not just policy pilots.”

“Across Europe, health systems are signaling impatience. Hospitals are pressing their EHR and middleware vendors to accelerate compliance beyond incremental API patches and deliver genuine plug-and-play interoperability,” added Brown.

Survey Methodology

Black Book surveyed 482 respondents including hospital CIOs, CMIOs, interoperability architects, and national eHealth leaders from Austria, Germany, France, Italy, Spain, Portugal, the Netherlands, and the UK. Comparative baselines were drawn from 2023 and 2024 Black Book Digital Health Trend datasets. Margin of error: ±4% at 95% confidence. The 2026 Black Book of Global Healthcare Information Technology, an updated 600 page industry resource will again be released in December,

About Black Book Research

Black Book Market Research is an independent global healthcare-technology intelligence firm analyzing more than 2,000 software, services, and infrastructure categories worldwide. All rankings and analytics are based exclusively on end-user feedback, with no vendor participation fees, influence, or sponsored adjustments. Founded in 2010, Black Book’s mission is to deliver transparent, data-driven performance metrics that advance healthcare transformation through evidence-based innovation for global providers, payers and health consumers..

Download complimentary HIT industry reports at www.blackbookmarketresearch.com or email research@blackbookmarketresearch.com.

SOURCE: Black Book Research

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