Digital health has been in the foreground of policy interest for the European Commission (EC) with the development of context-specific frameworks and targeted actions that facilitate the development of the European Health Data Space (EHDS). Through the development of the EDHS, the EC aspires to make electronic personal health data accessible to individuals across the EU by creating a single market for electronic health record systems that is interoperable with relevant medical devices and advanced health information systems across its member-states. This primary use of health data will be further consolidated with the creation of a consistent and reliable set-up that will enable their secondary use for research, innovation, regulatory activities, and effective, evidence-based policymaking. The secondary use of health data can provide significant benefits in the entire healthcare system and can further stimulate growth for the economy.
For health data to be effectively collected and processed for secondary use, country-specific policy contexts are essential pillars that provide the background through which the EHDS can achieve its ambitious goals. In a recent (2021) report by the Open Data Institute on the secondary use of health data in Europe, European economies were evaluated on the basis of the quality of their related policy activities and the progress made towards their implementation. Four broad groups emerged, were European economies are classified as leaders (strong policy quality, advanced implementation), limited energy (strong quality, less advanced implementation), limited vision (weaker policy quality, advanced implementation), and less prepared (lack in both dimensions). An overall evaluation of the classification suggests encouraging signs regarding the digital readiness of European health data ecosystems regarding the secondary use of health data, providing a fertile ground for the EHDS to build upon. However, there are some notable exceptions, with countries like Greece, Bulgaria, Hungary, Latvia, Romania, and Slovenia being at the early stages in both policymaking initiatives regarding the secondary use of health data and by extent in less advanced stages of implementation.
Focusing on the case of Greece, the state-of-the-art on the collection of health data is quite promising as 11 million users-patients, 60 thousand physicians (from both the public and the private sector) and 11 thousand healthcare service providers (including pharmacists) are already interconnected in an extensive network of information systems and data repositories. Furthermore, Greece’s Digital Transformation Strategy 2020-2025 (“Digital Bible”) has prioritized the digital transformation of the healthcare ecosystem, which is also strengthened by the Greece’s Recovery and Resilience Plan “Greece 2.0”. Within this context, several actions that include the interoperability among the different actors of the ecosystem are already well under way. However, the wealth of digital information deriving from the extensive catalogue of digital repositories and sources still remains unutilized, as a functional and regulatory gap can be traced in the stages that follow data collection in the health data value chain, which relates to their secondary processing and utilization.
A recent study by the Foundation for Industrial and Economic Research (FEIR/ΙΟΒΕ) and the Laboratory of Industrial and Energy Economics (LIEE) of the National Technical University of Athens (NTUA) for MSD Hellas3 suggested a remedy to tackle this gap in the secondary use of health data, through the creation of an excellence center with a dedicated mission to advance research and innovation on medical science and clinical practice through the proper collection and utilization of digital health data. This initiative is placed at the heart of the national digital health ecosystem and can contribute to the overall upgrade of healthcare and medical services in Greece, while at the same time create positive externalities to both the society and the national economy. Focusing on the latter dimension, the large-scale investment plan required for this endeavor can provide significant structural benefits for the economy. A quantitative approach based on adjusted input-output model estimated that each 1mil. € of investment in the project directly contributes 496k € in the national GDP, while the overall structural benefits – which include indirect effects from the stimulation of other economic activities that will support the implementation of this investment – is approximately 959k €. These benefits stimulate employment as well, as the direct contribution of 1mil. € investment for the creation and operation of a digital health data excellence center directly supports 13 job positions and has a multiplying contribution in the rest of the economy as well, which sums up in 24 job positions in total.
The establishment of a center of excellence based on the management, processing, and use of digital health data can provide the missing link of the health data value chain in Greece. Such an endeavour could serve as the core of an entire digital health ecosystem, receiving primary data from existing data sources and repositories, and processing them to deliver secondary evidence and other critical clinical information. Through this process, it can substantially support research and innovation in health sciences and significantly upgrade healthcare services for patients and individuals. Furthermore, it can also stimulate GDP and be a source of new, highly specialized job positions for the economy, providing a countermeasure to “brain-drain” both directly, through job creation, and indirectly, through the structural effects of related investments on other sectors. At the same time, it can also enhance “brain-gain”, by serving as an attraction of international scientific excellence.
What is necessary, however, for the successful implementation of these type of projects, is a strong regulatory framework that facilitates the secondary use of health data, while at the same time ensures personal data protection for individuals providing them. Greece is currently lagging in this dimension, and an urgent mobilization towards the design and rapid implementation of policy actions regarding secondary health data regulation is required. Such actions are essential not only for the successful integration of Greece in the EHDS, but also for the beneficial use of the large amounts of currently idle health data for both the society and the economy
 Secondary use of health data includes the combination of health data from multiple sources which are anonymized, aggregated, and analyzed to generate new insights that facilitate and promote research and innovation in the healthcare sector.