Cross-border healthcare enters new phase under European Health Data Space

Across Europe and beyond, real-world deployments now span teleconsultation, telemonitoring, tele-expertise exchange, teleradiology, telepathology, and even telesurgery. These services are already supporting chronic disease management, oncology care, intensive care monitoring, radiological diagnosis, pathology services in under-resourced regions, and highly specialized surgical procedures.

Telemedicine in Europe is moving from fragmented pilot projects to a regulated, cross-border healthcare system as the European Union accelerates the rollout of its landmark European Health Data Space framework. A new large-scale review of real-world telemedicine deployments shows that digital care is no longer a stopgap solution but a structural component of future healthcare delivery, with artificial intelligence, interoperability, and legal harmonization emerging as decisive forces shaping the next phase.

Published in Frontiers in Digital Health, the study titled “Telemedicine and the European Health Data Space: a new paradigm for healthcare in the EU” assesses how telemedicine operates across borders under the EU’s evolving digital health laws. Based on more than 80 peer-reviewed studies spanning 16 years, the research evaluates how the European Health Data Space, formalized under Regulation (EU) 2025/327, is reshaping healthcare access, clinical collaboration, and data governance across Member States.

Telemedicine moves from emergency tool to core health infrastructure

The review shows that telemedicine has matured far beyond basic video consultations. Across Europe and beyond, real-world deployments now span teleconsultation, telemonitoring, tele-expertise exchange, teleradiology, telepathology, and even telesurgery. These services are already supporting chronic disease management, oncology care, intensive care monitoring, radiological diagnosis, pathology services in under-resourced regions, and highly specialized surgical procedures.

Teleconsultation and telemonitoring dominate current use, particularly for chronic conditions such as diabetes, cardiovascular disease, and respiratory illnesses. Remote monitoring systems using sensors, mobile devices, and connected platforms have enabled earlier detection of complications and improved follow-up, especially for patients in rural or underserved areas. The study highlights that while outcomes vary by condition, evidence increasingly supports telemedicine as an effective complement to in-person care rather than a substitute.

More advanced applications reveal telemedicine’s strategic value in cross-border contexts. Teleradiology networks have enabled expert interpretation of medical imaging across multiple countries, addressing specialist shortages while maintaining quality through standardized reporting and quality assurance systems. Telepathology initiatives have allowed remote diagnosis in regions lacking pathology services, reducing delays and improving clinical decision-making. In surgical care, cross-border telesurgery and teleneuromonitoring demonstrate how high-speed networks and robotic systems can connect expertise across continents, albeit at high cost and technical complexity.

These deployments share a common lesson. Telemedicine works best when it is embedded within robust governance frameworks, interoperable health records, and trusted professional networks. Without those foundations, scalability and sustainability remain limited. This is where the European Health Data Space becomes decisive.

European Health Data Space reshapes the rules of cross-border care

The European Health Data Space is a regulatory framework designed to enable secure, interoperable exchange of electronic health data across the EU. Under the regulation, Member States are required to support standardized data exchange through MyHealth@EU, initially covering patient summaries and electronic prescriptions, with broader clinical data categories to follow.

The research makes clear that telemedicine is no longer peripheral to this framework. While MyHealth@EU was originally developed to support patient mobility and emergency care abroad, it is now positioned as a trust backbone for cross-border telemedicine. By allowing healthcare professionals to access accurate, translated health data across borders, the system reduces clinical risk and improves continuity of care in remote consultations.

However, the transition is far from seamless. Healthcare policy remains largely under national control, and the study documents persistent legal and regulatory barriers. These include uncertainty over professional liability, inconsistent recognition of medical qualifications, divergent consent requirements, and varying interpretations of data protection law. Even within the EU, these differences complicate telemedicine provision and discourage providers from scaling services across borders.

Organizational barriers are equally significant. Healthcare systems differ in structure, workflows, training standards, and digital maturity. Successful cross-border telemedicine initiatives typically rely on clearly defined roles, shared clinical protocols, and strong professional trust, often built through long-term collaboration rather than top-down mandates. The study warns that without scalable governance models, many current successes will remain limited to niche networks.

Financial uncertainty also looms large. Reimbursement rules for cross-border telemedicine are often unclear, inconsistent, or absent altogether. While EU law establishes general principles for reimbursement of cross-border care, telemedicine services are not uniformly included in national benefit packages. This creates uncertainty for patients and providers alike and undermines long-term investment.

Despite these challenges, the European Health Data Space provides the strongest foundation yet for overcoming fragmentation. By mandating interoperability standards, clarifying data exchange obligations, and embedding telemedicine within existing digital health infrastructure, the regulation creates conditions for telemedicine to scale safely and legally across the EU.

Artificial intelligence emerges as both accelerator and risk

AI is already being used to support remote monitoring, clinical decision-making, structured data processing, and language translation. In cross-border contexts, these capabilities are particularly valuable, helping clinicians manage large volumes of data, interpret complex cases, and overcome linguistic and semantic barriers.

The review highlights AI’s potential to streamline telemedicine workflows, reduce administrative burden, and improve diagnostic accuracy. Machine learning tools can support early warning systems for chronic disease management, assist in image analysis for radiology and pathology, and help standardize clinical documentation across languages and systems. AI-driven semantic mapping could play a key role in enabling meaningful interoperability within the European Health Data Space.

At the same time, the study is unequivocal about the risks. AI systems used in telemedicine often fall under the EU’s high-risk classification, triggering strict requirements under the AI Act and medical device regulations. Transparency, explainability, human oversight, and data protection are non-negotiable. Poorly governed AI could amplify existing inequalities, introduce new safety risks, or undermine trust in digital healthcare.

Infrastructure gaps further complicate AI deployment. Many regions lack the bandwidth, computing capacity, or cybersecurity protections required for AI-enabled telemedicine. Training shortages among healthcare professionals add another layer of difficulty, particularly in overstretched health systems.

The study argues that AI should be seen as an enabler rather than a shortcut. Its success depends on alignment with clinical practice, regulatory compliance, and integration into interoperable health systems. Without those safeguards, AI risks becoming another source of fragmentation rather than a solution.