eHealth4U: A pathway from the Cyprus eHealth law to a citizen-centred national EHR prototype interoperable with myHealth@EU and international patient summary

Objective Design, implement and evaluate eHealth4U, a prototype national electronic health record (EHR) system for Cyprus, so that the national eHealth law of Cyprus is operationalised into a citizen-centred service that remains interoperable with myHealth@EU and the International Patient Summary (IPS). Methods The provisions of the Cyprus eHealth law were analysed and translated into functional and non-functional requirements that structured the system's architecture, services and user-facing workflows. eHealth4U was implemented as a cloud-based microservices platform with authentication and authorisation controls, and interoperability based on the Fast Healthcare Interoperability Resources of Health Level Seven, including the IPS. The system verification comprised more than 400 unit test cases. Usability was assessed through task-based testing and questionnaires with 30 medical doctors and 57 patients, using key performance indicators such as task success, satisfaction and observed error occurrence. Interoperability was assessed using two x-eHealth hackathons and three IPS Connectathons. Results eHealth4U supports the IPS and myHealth@EU cross-border service requirements. Usability was rated 4.5/5, with a task success rate of 98% for doctors and 99% for patients, and an overall satisfaction of 95%. The observed error occurrence affected approximately 10% of doctors and 15% of patients at least once during task execution, whereas tasks were typically completed successfully after correction within the session. The IPS exchange was demonstrated with foreign partners in Connectathons, with successful participation documented through certificates issued by HL7 and Integrating the Healthcare Enterprise. Conclusion eHealth4U provides a legally grounded, citizen-centred and interoperable national EHR prototype for Cyprus, combining an implementable architecture with demonstrated cross-border interoperability and positive early usability outcomes, thereby supporting the establishment of the Cyprus Health Data Space.