Building a national health data ecosystem in Greece: Strategic pathways and readiness for the EHDS

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Background The development of health data spaces is a central pillar of digital health transformation across Europe. Greece is currently in a transitional phase, with several national initiatives focused on building digital health infrastructure and enhancing system maturity. However, systemic barriers, including fragmented governance, inconsistent interoperability, digital literacy gaps, and regulatory ambiguities, continue to impede progress. This study investigates the current status of Greece’s digital health ecosystem, identifying challenges, strategic opportunities, and enabling conditions for developing a national health data space aligned with the EHDS. Methods A qualitative research approach was employed, using semi-structured interviews with key stakeholders from Greece’s digital health ecosystem. Participants represented public authorities, industry, academia, and civil society. Thematic analysis was used to examine challenges across four core domains: technical infrastructure, governance, interoperability, and data readiness. Results Stakeholders reported persistent limitations in Greece’s health data ecosystem, including fragmented infrastructure, the absence of a centralized governance body, limited adoption of interoperability standards, and significant shortages in skilled IT personnel. Gaps remain in data sharing protocols, stakeholder coordination, data privacy, cybersecurity, and legal clarity regarding secondary data use. Findings were triangulated with desk research to enhance validity. Conclusion Advancing Greece’s transition to a fully operational health data space requires urgent alignment with EHDS regulations, targeted investment in digital and human infrastructure, and establishment of centralized governance to ensure resilience and long-term sustainability. Addressing workforce deficits and promoting multi-stakeholder collaboration will be essential for ensuring the resilience, trustworthiness, and longterm success of national digital health initiatives. Public interest summary This study examines the evolving digital health ecosystem in Greece within the broader context of the European Health Data Space initiative, which seeks to facilitate the secondary use of health data. Greece is currently transitioning its health data infrastructure, facing significant challenges in governance, interoperability, digital literacy, and regulatory alignment. Using a qualitative approach, the researchers conducted semi-structured interviews with stakeholders from various sectors, including public authorities, academia, and civil society. Thematic analysis revealed key limitations such as fragmented infrastructure, absence of centralized governance, insufficient interoperability standards, and IT workforce shortages. While national initiatives like the Electronic Prescription System and Electronic Health Record signal progress, significant barriers remain in data sharing, privacy, cybersecurity, and regulation of secondary data use. The study concludes that achieving a sustainable and interoperable health data space in Greece requires strategic policy alignment with EHDS, investment in infrastructure, and robust governance supported by stronger stakeholder engagement.