From Alignment to Acceleration: How i2X and Xt-EHR Collaboration Supports the Next Phase of EHDS Implementation

During the i2X Annual Meeting in Brussels, an important step was taken towards strengthening European coordination in digital health: the signing of a Memorandum of Understanding (MoU) between the i2X project and the Xt-EHR Joint Action.

Diogo Martins

May 6, 2026 · 3 min read

This agreement reflects more than a formal collaboration. It represents a shared recognition that the successful implementation of the European Health Data Space (EHDS) depends on continuity, alignment, and the effective reuse of existing work.

Building on what already exists

The Xt-EHR Joint Action has played a key role in advancing the development of the European Electronic Health Record Exchange Format (EEHRxF), contributing to specifications, frameworks, and policy alignment at the European level.

As i2X moves into its implementation phase, this work becomes a critical foundation.

Rather than starting from scratch, i2X builds on the outputs of Xt-EHR and other related initiatives, ensuring that implementation efforts are:

grounded in established specifications and frameworks
aligned with evolving regulatory and policy directions
consistent across countries and healthcare systems

This approach is essential to avoid fragmentation and duplication, enabling a more efficient and coherent transition towards EHDS.

From development to implementation

A key objective of the collaboration is to bridge the gap between framework development and real-world deployment.

While initiatives like Xt-EHR focus on defining and shaping the EEHRxF, i2X focuses on demonstrating how these frameworks can be applied in practice through real-world demonstrators.

This creates a complementary dynamic

Xt-EHR → defines and structures the framework
i2X → tests, validates, and implements it in real settings

Through this interaction, implementation challenges identified in i2X can inform further refinement of specifications, creating a continuous feedback loop between policy, standards, and practice.

Strengthening alignment across the ecosystem

The MoU also addresses a broader need within the European digital health landscape: the alignment of parallel initiatives.

As multiple EU-funded projects contribute to EHDS, ensuring coherence across efforts becomes critical.

The collaboration between i2X and Xt-EHR aims to:

strengthen coordination across projects and communities
support shared approaches to implementation
promote interoperability not only at the technical level, but across organisational and operational dimensions

This type of alignment is key to building a scalable and sustainable digital health ecosystem in Europe.

Creating a pathway for adoption

By combining the work of Xt-EHR with the implementation focus of i2X, the collaboration contributes to a clearer pathway for adoption of the EEHRxF.

It supports stakeholders in moving from understanding the framework to applying it in real-world healthcare environments

This is particularly important for healthcare providers, industry actors, and national authorities preparing for EHDS implementation.

Looking ahead

The MoU marks the beginning of a closer and more structured collaboration between the two initiatives.

As both projects progress, this partnership will play an important role in ensuring that:

Implementation efforts build on existing knowledge
Lessons learned are shared across the ecosystem
Europe moves forward in a coordinated and effective way

Ultimately, the success of the European Health Data Space will depend not only on innovation but on the ability to connect and build upon what has already been achieved.

The collaboration between i2X and Xt-EHR is a clear step in that direction.

Diogo Martins

Project Manager

Graduated in Health Equipment and Technology, with a background in Electronics, ICT, and Medical Devices. Holds an MSc in Healthcare Information Systems Management from the Polytechnic Institute of Leiria and the Faculty of Medicine of Porto. Diogo has worked as a Medical Devices Consultant, Key Account Manager, and ICT Project Manager at SPMS, with a focus on healthcare data sharing, radiology, and telemedicine. He has coordinated and participated in multiple EU digital health projects (e.g., X-eHealth, eHAction, HEALTHeID) related to patient empowerment, health data use, interoperability, and sustainability.

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