National electronic health records in Europe and the US: who runs them, which standards they use, how to connect

Short answer: almost every European country now runs a national health record infrastructure, but no two look alike. Some are central records (Austria's ELGA, Poland's P1, France's Mon espace santé); some are federations of regional records with a national index (Italy's FSE, Spain's HCDSNS); some are exchange networks without a central record (the Netherlands' LSP and MedMij, Germany's Telematikinfrastruktur with the insurer-hosted ePA); England has a national backbone (Spine) with regional shared records; the United States has no national record but a network-of-networks (TEFCA) and a federal data standard (USCDI). Most started on CDA documents and IHE profiles and are adding FHIR APIs; the EHDS will require all EU systems to exchange the same priority data in the European EHR exchange format through MyHealth@EU.

The map

Europe's national electronic health record systems fall into a few recognisable shapes: Germany, France, Austria, Poland and the Nordic countries run central or insurer-hosted records, Italy and Spain federate regional records through a national node, the Netherlands relies on exchange networks, England on the NHS Spine backbone, and the United States on networks of networks under TEFCA.

Country pages: Germany, France, Italy, Spain, Netherlands, United Kingdom, Austria, Poland, and the cross-border layer, MyHealth@EU. For the US, see TEFCA and USCDI.

Four models

National health record infrastructures in Europe and the United States follow four models: a central record that every provider writes to, federated regional records joined by a national index, an exchange network with no central store, and a network of networks under a common agreement. Each model shapes how patients see their data and how vendors connect.

Central record. One national store, usually document-based, that every provider writes to and the patient sees in one portal (Austria, Poland, France, the Nordics, Estonia). Simple for patients; the vendor connects once, to one specification; the price is a large central system and a long specification cycle.

Federated regions with a national index. Regions keep their own records; a national layer finds and fetches across them (Italy, Spain). Reflects decentralised health systems; the vendor onboards per region, with national rules for the cross-region part.

Exchange network. No central record; a national switch or a trust framework lets authorised systems query each other and lets patients collect their data in an app of their choice (Netherlands; Germany's TI with the ePA hosted by insurers). Privacy-friendly and vendor-neutral; the hard part is making every system actually answer.

Network of networks. Private networks connect to each other under a common agreement, with a federal data standard but no federal record (United States). Flexible, uneven coverage, strong on documents, moving to FHIR.

What they share

Despite their different architectures, Europe's national health record systems share four traits: a national patient identifier with a strong citizen login, a start with CDA documents before structured FHIR data, a shift from opt-in to opt-out enrolment, and the patient summary and e-prescription as the first services exchanged across borders through MyHealth@EU.

• Identity first. A national patient identifier (INS in France, NHS number, Krankenversichertennummer, PESEL-linked IDs) and a strong citizen login (eIDAS-notified schemes, NHS login, ID Austria).
• Documents before data. Most systems began by exchanging CDA documents (discharge letters, reports, summaries) through IHE XDS registries; structured FHIR data came later, led by medication, vaccination and lab results.
• Opt-out replaced opt-in. Germany (2025), France, Austria and others moved to records created by default with a right to object, after opt-in programmes stalled.
• The patient summary and e-prescription first across borders. These are the two services every country joined MyHealth@EU with, and the first two priority categories under the EHDS.

How a vendor connects

A software vendor connects to a European national health record by finding the operator's developer programme, meeting its certification and hosting requirements, implementing the national FHIR or CDA profiles and identity integration, testing in the national sandbox and completing onboarding. Each country keeps its own route; the EHDS adds a common European exchange format on top.

1. Identify the operator and its developer programme: gematik, ANS, the Italian Ministry's FSE 2.0 documentation, NHS England's API catalogue, MedMij, ELGA GmbH, CeZ.
2. Read the conformance requirements: certification or referencing (Ségur in France, MedMij labels, DTAC in England, gematik approval), hosting (HDS in France), security (DSPT, ISO 27001).
3. Implement the national profiles: the country's FHIR core (UK Core, nl-core, the German Basisprofile, ELGA CDA guides) and the identity integration.
4. Test against the national sandbox or reference environment, then go through onboarding.
5. Plan for the EHDS: the European EHR exchange format and the patient-access obligations will apply on top of national rules, with the first deadlines around 2029.

For a personal record

A personal, patient-controlled health record does not replace Europe's national health record systems. It gathers what a person is entitled to receive from each national system, through patient access, downloads, documents and clinic connections, into one FHIR record under the person's control, which they can then share with any clinic in any country.

A patient-controlled record such as Anpheros does not replace the national system; it collects what the person is entitled to from each of them (through patient access APIs, downloads, documents and clinic connections) into one FHIR record the person controls, and gives it back to any clinic the person chooses, in any country. See Health data portability and How to transfer your medical records.

National systems change often. This page describes the situation as published by the operators linked under Sources, last reviewed in October 2026; the operator's documentation is the authority for connection requirements.

Related pages

• MyHealth@EU and the cross-border patient summary
• Your medical data in the EU: GDPR, EHDS and your rights
• Health records online: EU, UK and US
• Health data portability
• TEFCA and QHINs explained
• Healthcare interoperability standards: the map

Sources

• European Commission: European Health Data Space
• European Commission: MyHealth@EU
• gematik: elektronische Patientenakte
• ANS: Mon espace santé
• Italy: Fascicolo Sanitario Elettronico
• NHS England: API and integration catalogue
• MedMij
• ELGA GmbH
• Centrum e-Zdrowia (Poland)

Frequently asked questions

Which country has the most complete national record?

Estonia, Denmark and Finland have had near-universal national records for over a decade; Austria's ELGA and Poland's P1 are complete for documents and prescriptions; Germany's ePA became the largest by population after the 2025 opt-out rollout. Completeness of structured data varies everywhere.

Can a vendor connect to all of them with one integration?

Not yet. Each has its own identity, onboarding and profiles. The EHDS aims to make the exchange format common; connection and certification will remain national for the foreseeable future.

Do national records talk to each other?

Through MyHealth@EU for the patient summary and ePrescription between participating countries; more categories (lab results, images, discharge reports) are being added under the EHDS. Outside that, cross-border exchange is manual.

Where does the United States fit?

It has no national record. Exchange runs through networks (Carequality, CommonWell, now TEFCA QHINs) with a federal data standard (USCDI) and patient access rights to provider APIs.

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