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The European Health Data Space and the Geopolitics of EU Sovereignty

Introduction The European Health Data Space (EHDS) is geopolitically important because it translates the European Union’s abstract ambition for “digital sovereignty” into a concrete institutional, legal, and technical system for one of the most sensitive categories of data: health data. Regulation (EU) 2025/327 formally establishes the EHDS as an EU-wide framework for the primary and secondary use of electronic health data; it entered into force on 26 March 2025, applies from 26 March 2027, and will be implemented in phases through 2029, 2031, and 2035 (Regulation (EU) 2025/327, 2025). ( EUR-Lex ) Its importance lies not only in improving healthcare delivery or research efficiency, but in determining whether the EU is capable to govern, standardise, secure, and exploit strategic data infrastructures according to its own constitutional values rather than by defaulting to foreign platforms, fragmented national systems, or private-sector gatekeepers. In this essay I want to argue that the...
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Organising and running a Hospital Under DRG Financing: Efficiency, Safety, Co-Governance, and the Quintuple Aim

Introduction Organizing and running a hospital under Diagnosis-Related Group (DRG) financing requires an intricate balance of clinical excellence, streamlined operational logistics, financial sustainability, and patient-centric governance. Successfully steering a medical facility under these conditions demands blending top-tier patient care with complex legal and administrative frameworks to maintain patient safety, regulatory compliance, and a resilient workforce. Diagnosis-Related Group (DRG) financing changes the managerial problem of the acute hospital. Instead of being reimbursed primarily for every input consumed, the hospital is paid, wholly or partly, according to case-mix groups that are intended to reflect clinically meaningful and resource-homogeneous episodes of care. In principle, this improves transparency, allows comparison of hospital activity, and creates incentives to reduce unnecessary length of stay, avoid inefficient resource use, and improve throughput (Busse et a...
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Shift-Left EHR Data Quality as a Patient-Safety Strategy in European Acute Hospitals

Introduction A “shift-left” data quality strategy in an Electronic Health Record (EHR) means that data are validated, standardized, governed, and made clinically usable at the point where they are created, rather than corrected later in a data warehouse, registry, audit process, medical coding or AI pipeline. In a European acute hospital, this is not merely an informatics improvement. It is a patient-safety intervention, a clinical governance obligation, and a regulatory compliance strategy under the General Data Protection Regulation (GDPR), the European Health Data Space Regulation (EHDS), and the Artificial Intelligence Act when EHR data feed AI-enabled clinical decision support systems. The central argument of my essay is that a shift-left EHR data quality strategy should be implemented as a risk-based clinical safety programme, not as a purely technical data-cleaning project. It should prioritize data elements that directly affect diagnosis, medication safety, care escalation, han...
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