EU EEHRxF: The Future of European Health Record Exchange

Executive Summary

The European Electronic Health Record Exchange Format (EEHRxF) is the EU’s ambitious framework for enabling seamless, standards-based health record exchange across all 27 member states. Built on FHIR R4 and aligned with the International Patient Summary (IPS), EEHRxF represents the future of cross-border healthcare in Europe—allowing Irish citizens to access their complete health records anywhere in the EU, and vice versa.

This comprehensive guide covers the EEHRxF specification, its relationship to existing EU health initiatives (eHDSI, IPS, ePrescribing), Ireland’s readiness and participation, FHIR implementation patterns, and the strategic roadmap for 2025-2030.

What You’ll Learn:

• EEHRxF vision and strategic goals
• Technical architecture (FHIR-based)
• Relationship to IPS, eHDSI, and national EHR systems
• Ireland’s HSE alignment and readiness
• FHIR resource mappings and profiles
• Data governance and GDPR compliance
• Implementation roadmap (2025-2030)
• Production .NET integration code

Tech Stack: FHIR R4 | IPS Profile | EEHRxF Specification | .NET 10 | Azure | EU eHealth Network

The Vision

Problem Statement:

• 27 EU countries = 27 different EHR systems
• No common format for health records
• Cross-border care requires manual data transfer
• Patients’ medical history lost when traveling
• Emergency care delayed by lack of information

EEHRxF Solution:
A unified FHIR-based specification that defines:

• Standard clinical dataset (what data to exchange)
• FHIR resource profiles (how to structure data)
• Terminology bindings (SNOMED CT, LOINC, etc.)
• Security and privacy requirements (GDPR-compliant)
• Technical infrastructure (EU gateways)

Key Principles

1. FHIR-First

   • Built entirely on HL7 FHIR R4
   • Leverages IPS (International Patient Summary)
   • Uses standard FHIR resources (Patient, Observation, etc.)

2. Patient-Centric

   • Patients control their data
   • Consent-based access
   • Portable health records

3. Interoperable

   • Works with existing national systems
   • No "rip and replace" required
   • Incremental adoption

4. Privacy-Preserving

   • GDPR Article 9 compliant (health data)
   • Audit trails for all access
   • Data minimization (only share what’s needed)

Understanding the Relationship

How They Work Together

IPS (International Patient Summary)

• Scope: Minimal emergency data
• Content: Allergies, medications, active problems, vaccinations
• Use Case: Emergency care abroad
• Size: Small (~50KB)

eHDSI (eHealth Digital Service Infrastructure)

• Scope: Patient Summary + ePrescription
• Content: IPS + prescription data
• Use Case: Planned + emergency care, pharmacy
• Infrastructure: EU gateways, NCPs (National Contact Points)

EEHRxF (European EHR Exchange Format)

• Scope: Complete health record
• Content: Full medical history (encounters, lab results, imaging, procedures, care plans)
• Use Case: Continuity of care, specialist consultations, chronic disease management
• Size: Large (potentially MBs)

Evolution Path

2015-2020: eHDSI Pilot (Patient Summary + ePrescription)
2019: IPS becomes global standard
2021-2023: EEHRxF Development
2024-2025: EEHRxF Pilot Countries
2026-2028: Gradual EU Rollout
2029-2030: Full EU Deployment

Three-Layer Design

Layer 1: National EHR Systems

• Each country maintains its own EHR infrastructure
• Various technologies: FHIR R4, CDA, HL7 v2, proprietary
• Examples:
  • Ireland: HSE iHealthRecord (FHIR-based)
  • Finland: Kanta (national EHR)
  • Estonia: X-Road (distributed)
  • Spain: Regional systems (varying formats)

Layer 2: EEHRxF FHIR Profiles

• Standard FHIR R4 resource profiles
• Translation/mapping from national formats
• Operated by National Contact Points (NCPs)
• Ensures semantic interoperability

Layer 3: EU Infrastructure

• EU eHealth Gateway (central routing)
• Patient consent management
• GDPR audit logging
• Cross-border authentication

Mandatory Data Elements

Optional (Extended) Data

HSE Strategic Positioning

Strong Foundation (2025):

✅ FHIR-First Strategy

• HSE iHealthRecord built on FHIR R4
• All new integrations require FHIR
• Training programs for FHIR development

✅ Individual Health Identifier (IHI)

• National patient identifier
• 5+ million Irish citizens registered
• Aligned with EU patient identification

✅ eHealth Infrastructure

• Healthlink network operational
• GP practice connectivity
• Hospital EMR integrations

✅ eHDSI Participation

• IPS pilot active (10 hospitals)
• ePrescription pilot (2026)
• NCP infrastructure deployed

Challenges & Roadmap

Challenges:

• Legacy systems (HL7 v2, CDA)
• Multiple EMR vendors (Cerner, Epic, InterSystems)
• GP practice system variations
• Resource constraints

2025-2030 Roadmap:

2025-2026: Preparation

• FHIR profile development (EEHRxF)
• Pilot with 5 hospitals
• NCP enhancement
• Training programs

2027-2028: Pilot

• Full hospital EEHRxF deployment (20 sites)
• GP practice integration (500 practices)
• Cross-border testing (Finland, Spain)

2029-2030: Production

• National rollout
• All acute hospitals
• 2000+ GP practices
• Full EU participation

Generating EEHRxF Bundle (.NET)

using Hl7.Fhir.Model;
using Hl7.Fhir.Rest;

public class EEHRxFGenerator
{
    private readonly FhirClient _fhirClient;

    public async Task<Bundle> GenerateEEHRxFBundle(string patientIHI)
    {
        // 1. Create document bundle
        var bundle = new Bundle
        {
            Type = Bundle.BundleType.Document,
            Meta = new Meta
            {
                Profile = new[]
                {
                    "http://hl7.eu/fhir/StructureDefinition/Bundle-eu-eehrxf"
                },
                VersionId = "1.0",
                LastUpdated = DateTimeOffset.Now
            }
        };

        // 2. Composition (table of contents)
        var composition = CreateComposition(patientIHI);
        bundle.Entry.Add(new Bundle.EntryComponent { Resource = composition });

        // 3. Patient
        var patient = await GetPatient(patientIHI);
        bundle.Entry.Add(new Bundle.EntryComponent { Resource = patient });

        // 4. Allergies (mandatory)
        var allergies = await GetAllergies(patientIHI);
        foreach (var allergy in allergies)
        {
            bundle.Entry.Add(new Bundle.EntryComponent { Resource = allergy });
        }

        // 5. Medications (mandatory)
        var medications = await GetMedications(patientIHI);
        foreach (var med in medications)
        {
            bundle.Entry.Add(new Bundle.EntryComponent { Resource = med });
        }

        // 6. Conditions (mandatory)
        var conditions = await GetConditions(patientIHI);
        foreach (var condition in conditions)
        {
            bundle.Entry.Add(new Bundle.EntryComponent { Resource = condition });
        }

        // 7. Lab results (last 2 years)
        var labResults = await GetLabResults(patientIHI, months: 24);
        foreach (var lab in labResults)
        {
            bundle.Entry.Add(new Bundle.EntryComponent { Resource = lab });
        }

        // 8. Procedures (last 5 years)
        var procedures = await GetProcedures(patientIHI, years: 5);
        foreach (var proc in procedures)
        {
            bundle.Entry.Add(new Bundle.EntryComponent { Resource = proc });
        }

        // 9. Immunizations
        var immunizations = await GetImmunizations(patientIHI);
        foreach (var imm in immunizations)
        {
            bundle.Entry.Add(new Bundle.EntryComponent { Resource = imm });
        }

        // 10. Encounters (last year)
        var encounters = await GetEncounters(patientIHI, months: 12);
        foreach (var enc in encounters)
        {
            bundle.Entry.Add(new Bundle.EntryComponent { Resource = enc });
        }

        return bundle;
    }

    private Composition CreateComposition(string patientIHI)
    {
        return new Composition
        {
            Status = CompositionStatus.Final,
            Type = new CodeableConcept
            {
                Coding = new List<Coding>
                {
                    new Coding(
                        "http://loinc.org",
                        "60591-5",
                        "Patient Summary Document"
                    )
                }
            },
            Subject = new ResourceReference($"Patient/{patientIHI}"),
            Date = DateTimeOffset.Now.ToString("yyyy-MM-ddTHH:mm:sszzz"),
            Author = new List<ResourceReference>
            {
                new ResourceReference("Organization/HSE-IE")
            },
            Title = "European Electronic Health Record Exchange Format",
            Custodian = new ResourceReference("Organization/HSE-IE")
        };
    }
}

EU EEHRxF Specifications

• EU EEHRxF Official Site
• EEHRxF FHIR Implementation Guide
• EU eHealth Network

FHIR Foundation

• FHIR R4 Specification
• IPS Implementation Guide
• Firely .NET SDK

EU Initiatives

• eHDSI Portal
• MyHealth@EU
• EU GDPR

Irish Healthcare

• HSE eHealth Ireland
• IHI Programme
• HSE Digital Strategy 2025-2030

Terminology

• SNOMED CT
• LOINC
• WHO ATC
• ICD-11

Implementation Resources

• HL7 Europe
• Gazelle Testing Platform
• FHIR Validator

This article completes our comprehensive 10-part series on Healthcare IT Standards and EU/Ireland Healthcare Interoperability. We’ve covered:

1. HL7 v2 – The legacy standard powering 95% of hospital interfaces
2. HSE Digital Transformation – Ireland’s eHealth journey
3. GDPR + FHIR – Privacy-compliant healthcare APIs
4. CDA – XML clinical documents
5. EMR Modernization – Migrating v2 to FHIR
6. HL7 v3 – The failed successor (lessons learned)
7. IPS – Emergency healthcare across EU borders
8. FHIR Subscriptions – Real-time event-driven systems
9. ePrescribing – Electronic prescriptions in EU/Ireland
10. EU EEHRxF – The future of European health records

Key Takeaways:

• FHIR is the future (REST APIs, JSON, modern)
• HL7 v2 will persist for years (95% of hospitals)
• EU is leading interoperability (IPS, eHDSI, EEHRxF)
• Ireland well-positioned (FHIR-first, IHI, eHealth Ireland)
• GDPR compliance is non-negotiable

For Irish solution architects and healthcare IT professionals, mastering these standards is essential for building the next generation of healthcare systems.

1. HL7 v2: The Messaging Standard
2. HSE Digital Transformation
3. GDPR + FHIR Compliance
4. CDA Clinical Documents
5. EMR Modernization
6. HL7 v3 Overview
7. IPS in EU
8. FHIR Subscriptions
9. ePrescribing

The European Electronic Health Record Exchange Format represents the EU’s most ambitious healthcare interoperability initiative to date. By building on proven standards (FHIR, IPS) and existing infrastructure (eHDSI), EEHRxF will enable true continuity of care across Europe—ensuring that Irish patients receive the same quality of care whether in Dublin, Barcelona, or Berlin.

For Irish healthcare IT professionals and solution architects, understanding EEHRxF is crucial for preparing systems for the inevitable EU-wide integration. The HSE’s investment in FHIR, IHI, and eHealth infrastructure positions Ireland to be an early adopter and EU leader in this transformation.