What I learned about EHDS readiness in the Nordics at Vitalis 2026

Last week at Vitalis I spent a lot of time in conversations with people who are not deep in the FHIR world: regional health authorities, government officials, healthcare IT leads from across the Nordics.

What struck me is how seriously EHDS is being taken, and how much work is still ahead to translate that seriousness into actual implementation. A few things stood out.

A wake-up call for every system, not just EHRs

On the Open Stage, together with Olof Mattsson and Erland Riis Lavsen from Service Well, I ran through the list of systems EHDS actually reaches.

Hospital information systems, laboratory systems, radiology, pharmacy, GP and specialist EHRs, physiotherapy systems, patient-facing apps, wellness apps, medical devices. The EHDS definition of what counts as an EHR is broad. Broader than most vendors in the room expected.

The technical requirements underneath that scope are equally specific. Each system needs to implement a common API: FHIR-based resource access patterns from IPA (International Patient Access), document exchange through MHD transactions, patient matching via PDQm, capability discovery, SMART-based authorization, and audit trail logging.

For organizations still running non-FHIR infrastructure, that is not a small list.

I opened with a slide that said: “HEY YOU! WAKE UP!” Not because the audience was unaware of EHDS, but because awareness and readiness are two different things. Most people in the room understood the policy landscape. Fewer had thought through what it means for their specific systems.

Sweden’s layered EHDS challenge

One of my bigger takeaways from the week was actually specific to Sweden. Traditionally, Swedish regions carry the burden of health data exchange. That has worked fine for regional coordination, but EHDS puts obligations at the national level, and the central government is responding.

The national e-health agency is expanding and actively hiring. Where the regions once owned terminology governance, the national layer is now taking coordination back. A national terminology server is in the works, alongside patient portal infrastructure, security layers, and translation services that all need to be built centrally.

What I described in the session was a layered architecture: individual systems implementing EHDS at the hospital or clinic level, regions aggregating those implementations, and the national layer building on top of that.

It is not how the Netherlands approached it (we largely skipped the regional aggregation step), but the Swedes are culturally a lot like us. They solve problems by talking. So for Sweden, this kind of layered, collaborative approach is probably the most natural fit for how they get there.

The vendor consolidation question

That same evening we hosted an industry roundtable with Service Well, bringing together a small group of senior people from government, policy, and healthcare.

We ran three table discussions on: how regions with multiple EHR systems can actually use EHDS and FHIR APIs to create clinical value; what health data access across borders realistically looks like by 2035; and terminology, vendor capability, and patient-driven innovation.

One thing that came up at my table that I found really interesting: several of the Swedish participants thought a lot of smaller vendors will struggle to meet EHDS compliance requirements. We are talking about two-person shops running systems that have been around for decades.

The engineering lift is genuinely significant. Whether those vendors find a path through or not, it is something smaller vendors across Europe will need to think hard about.

Something that came through clearly in the discussions: reaching basic compliance and data exchange is one thing, but getting real clinical value out of it takes more. Governance, the right architecture, and expertise across the whole stack, not just at the API layer.

What I took away

The thing I keep coming back to is that EHDS is good news for hospitals that want more from their data. It gives the whole market a shared framework to build on, which makes the conversations about what is possible a lot more concrete.

The distributed approach EHDS requires is also genuinely new: interoperability at every level, individual systems talking to regions talking to a national layer, rather than everything funneled into one centralized system.

The message Olof and Erland from Service Well closed the session with was: start before you are ready. Build capability through implementation, not planning.

Use EHDS as a forcing function on your data models, your governance, your procurement language, before March 2027 arrives and the first deadlines kick in for patient summaries, electronic prescriptions, electronic dispensations, medical images and image reports, laboratory results, and discharge reports.

I would agree. The organizations I am watching are the ones treating this as an architecture question now, not a compliance project for later. If you want to dive into what that looks like in practice, I am happy to talk.